| Yourtowndoctor Llc | |
|
3665 Swiftwater Park Dr Ste 307 Suwanee GA 30024-7179 | |
| (478) 361-6055 | |
| Not Available |
| Full Name | Yourtowndoctor Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3665 Swiftwater Park Dr Ste 307, Suwanee, Georgia |
| Authorized Official Name and Position | Katherine Wiegman (OWNER) |
| Authorized Official Contact | 4783616055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Yourtowndoctor Llc 2902 Planters Mill Dr Dacula GA 30019-1680 Ph: (478) 361-6055 | Yourtowndoctor Llc 3665 Swiftwater Park Dr Ste 307 Suwanee GA 30024-7179 Ph: (478) 361-6055 |
| NPI Number | 1750041075 |
|---|---|
| Provider Enumeration Date | 12/28/2021 |
| Last Update Date | 12/28/2021 |
| Medicare PECOS PAC ID | 4880087972 |
|---|---|
| Medicare Enrollment ID | O20220214001766 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750041075 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Katherine E Wiegman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881861839 PECOS PAC ID: 6507014552 Enrollment ID: I20220215002315 |
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