| 1st Genesis Treatment Center Inc | |
|
1022 Hillcrest Pkwy Ste 100 Dublin GA 31021-4258 | |
| (478) 272-5020 | |
| (478) 272-5024 |
| Full Name | 1st Genesis Treatment Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1022 Hillcrest Pkwy Ste 100, Dublin, Georgia |
| Authorized Official Name and Position | Nathaniel Veal (OWNER) |
| Authorized Official Contact | 4783617077 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 1st Genesis Treatment Center Inc 1022 Hillcrest Pkwy Ste 100 Dublin GA 31021-4258 Ph: (478) 272-5020 | 1st Genesis Treatment Center Inc 1022 Hillcrest Pkwy Ste 100 Dublin GA 31021-4258 Ph: (478) 272-5020 |
| NPI Number | 1265277073 |
|---|---|
| Provider Enumeration Date | 06/25/2024 |
| Last Update Date | 06/25/2024 |
| Medicare PECOS PAC ID | 7012455751 |
|---|---|
| Medicare Enrollment ID | O20240813003312 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265277073 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Antonio Renaldo Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679041107 PECOS PAC ID: 1557794187 Enrollment ID: I20191211003010 |
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