| Vitamedx | |
|
6254 Memorial Dr Ste F Stone Mountain GA 30083-2884 | |
| (770) 558-1029 | |
| Not Available |
| Full Name | Vitamedx |
|---|---|
| Speciality | Clinic/Center |
| Location | 6254 Memorial Dr Ste F, Stone Mountain, Georgia |
| Authorized Official Name and Position | Andrea Caeser (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6784883902 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitamedx 6254 Memorial Dr Ste F Stone Mountain GA 30083-2884 Ph: (770) 558-1029 | Vitamedx 6254 Memorial Dr Ste F Stone Mountain GA 30083-2884 Ph: (770) 558-1029 |
| NPI Number | 1467183996 |
|---|---|
| Provider Enumeration Date | 06/24/2022 |
| Last Update Date | 10/02/2022 |
| Medicare PECOS PAC ID | 0648656421 |
|---|---|
| Medicare Enrollment ID | O20220930002536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467183996 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Andrea Flo Caesar |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1477841336 PECOS PAC ID: 5193997161 Enrollment ID: I20221005002290 |
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