| Whole Family Medicine, Llc | |
|
402 W Ponce De Leon Ave Decatur GA 30030-2443 | |
| (404) 377-9010 | |
| (404) 935-0254 |
| Full Name | Whole Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 402 W Ponce De Leon Ave, Decatur, Georgia |
| Authorized Official Name and Position | Marion Kaylor Owen (PRESIDENT) |
| Authorized Official Contact | 4043957845 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whole Family Medicine, Llc 402 W Ponce De Leon Ave Decatur GA 30030-2443 Ph: (404) 377-9010 | Whole Family Medicine, Llc 402 W Ponce De Leon Ave Decatur GA 30030-2443 Ph: (404) 377-9010 |
| NPI Number | 1053589481 |
|---|---|
| Provider Enumeration Date | 02/19/2008 |
| Last Update Date | 06/21/2024 |
| Medicare PECOS PAC ID | 0345323093 |
|---|---|
| Medicare Enrollment ID | O20080219000191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053589481 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Marion K Owen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376586347 PECOS PAC ID: 3173416260 Enrollment ID: I20040203000871 |
| Provider Name | Susan Castle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083858716 PECOS PAC ID: 9931396595 Enrollment ID: I20101208000475 |
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