| Vituity-georgia Intensivists Pc | |
|
450 N Candler St Decatur GA 30030-2626 | |
| (404) 501-6100 | |
| Not Available |
| Full Name | Vituity-georgia Intensivists Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 450 N Candler St, Decatur, Georgia |
| Authorized Official Name and Position | Theophile G. Koury (PRESIDENT) |
| Authorized Official Contact | 5103502600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vituity-georgia Intensivists Pc 2100 Powell St Ste 400 Emeryville CA 94608-1872 Ph: (510) 350-2600 | Vituity-georgia Intensivists Pc 450 N Candler St Decatur GA 30030-2626 Ph: (404) 501-6100 |
| NPI Number | 1770348500 |
|---|---|
| Provider Enumeration Date | 02/20/2024 |
| Last Update Date | 07/19/2024 |
| Medicare PECOS PAC ID | 8820438229 |
|---|---|
| Medicare Enrollment ID | O20240502001573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770348500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Lawrence Eugene Wilson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1962633164 PECOS PAC ID: 3476773417 Enrollment ID: I20140925001539 |
| Provider Name | Dong Vien Dang |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1275875551 PECOS PAC ID: 3375864192 Enrollment ID: I20210427001442 |
| Provider Name | Mohanad Abu Speitan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942563820 PECOS PAC ID: 7618286675 Enrollment ID: I20210713003680 |
| Provider Name | Charles Oribabor |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1609826346 PECOS PAC ID: 9234128935 Enrollment ID: I20221222000064 |
| Provider Name | Allison Harriott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023247871 PECOS PAC ID: 6709028616 Enrollment ID: I20240514003136 |
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