| My Heart Doctor | |
|
110 Rushing Ln Statesboro GA 30458-6027 | |
| (912) 243-9274 | |
| Not Available |
| Full Name | My Heart Doctor |
|---|---|
| Speciality | Internal Medicine |
| Location | 110 Rushing Ln, Statesboro, Georgia |
| Authorized Official Name and Position | Kendall M Griffith (OWNER) |
| Authorized Official Contact | 3406432227 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Heart Doctor Po Box 2027 Statesboro GA 30459-2027 Ph: (912) 243-9274 | My Heart Doctor 110 Rushing Ln Statesboro GA 30458-6027 Ph: (912) 243-9274 |
| NPI Number | 1174006159 |
|---|---|
| Provider Enumeration Date | 09/14/2018 |
| Last Update Date | 08/03/2023 |
| Medicare PECOS PAC ID | 8224380498 |
|---|---|
| Medicare Enrollment ID | O20181016003841 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174006159 | NPI | - | NPPES |
| Provider Name | Brittany Bacot |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285078147 PECOS PAC ID: 0749429413 Enrollment ID: I20130611000176 |
| Provider Name | Tristia Knight |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134524036 PECOS PAC ID: 0143547893 Enrollment ID: I20150318000760 |
| Provider Name | David Wayne Lariscy |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1134362718 PECOS PAC ID: 1254573009 Enrollment ID: I20160304000984 |
| Provider Name | Kendall Griffith |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1710968060 PECOS PAC ID: 4880582048 Enrollment ID: I20171004002192 |
| Provider Name | Lindsay Jenkins Barnard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083387690 PECOS PAC ID: 9436540077 Enrollment ID: I20211215002170 |
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