| Starr's Mill Internal Medicine, Llc | |
|
1330 Highway 74 May House Fayetteville GA 30215-2950 | |
| (770) 631-2502 | |
| (770) 631-2503 |
| Full Name | Starr's Mill Internal Medicine, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1330 Highway 74, Fayetteville, Georgia |
| Authorized Official Name and Position | Anthony F Lawson (PRESIDENT) |
| Authorized Official Contact | 7706312502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Starr's Mill Internal Medicine, Llc 1330 Highway 74 May House Fayetteville GA 30215-2950 Ph: (770) 631-2502 | Starr's Mill Internal Medicine, Llc 1330 Highway 74 May House Fayetteville GA 30215-2950 Ph: (770) 631-2502 |
| NPI Number | 1689724809 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 03/19/2010 |
| Medicare PECOS PAC ID | 1658328661 |
|---|---|
| Medicare Enrollment ID | O20050401000447 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689724809 | NPI | - | NPPES |
| DC7883 | Other | GA | RAILROAD MEDICARE GRP # |
| 11D0983347 | Other | GA | CLIA # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Georgia) | Primary |
| 208000000X | Pediatrics | (Georgia) | Secondary |
| Provider Name | Anthony F Lawson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336257831 PECOS PAC ID: 8224027701 Enrollment ID: I20040510001148 |
| Provider Name | John S Brachey |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558459768 PECOS PAC ID: 3173512688 Enrollment ID: I20040510001254 |
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