| Treken Primary Care Inc | |
|
777 Cleveland Ave Sw Atlanta GA 30315-7129 | |
| (404) 305-0004 | |
| (404) 305-0494 |
| Full Name | Treken Primary Care Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 777 Cleveland Ave Sw, Atlanta, Georgia |
| Authorized Official Name and Position | Cherylance Farnum (PROVIDER) |
| Authorized Official Contact | 4043050004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Treken Primary Care Inc 777 Cleveland Ave Sw Atlanta GA 30315-7129 Ph: (404) 305-0004 | Treken Primary Care Inc 777 Cleveland Ave Sw Atlanta GA 30315-7129 Ph: (404) 305-0004 |
| NPI Number | 1588169759 |
|---|---|
| Provider Enumeration Date | 03/28/2018 |
| Last Update Date | 09/05/2019 |
| Medicare PECOS PAC ID | 0749545127 |
|---|---|
| Medicare Enrollment ID | O20180606001250 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588169759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RA0000X | Internal Medicine - Adolescent Medicine | (* (Not Available)) | Primary |
| Provider Name | Divina N Dyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285835769 PECOS PAC ID: 5698869162 Enrollment ID: I20070915000029 |
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