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1401 Johnson Ferry Rd Ste 390b Marietta GA 30062-6495 | |
| (470) 250-1492 | |
| (470) 235-7311 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1401 Johnson Ferry Rd Ste 390b, Marietta, Georgia |
| Authorized Official Name and Position | Leia Dawson (MEDICAL DIRECTOR/ EXECUTIVE OFFICER) |
| Authorized Official Contact | 4702501492 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1401 Johnson Ferry Rd Ste 390b Marietta GA 30062-6495 Ph: (470) 250-1492 | 1401 Johnson Ferry Rd Ste 390b Marietta GA 30062-6495 Ph: (470) 250-1492 |
| NPI Number | 1275300287 |
|---|---|
| Provider Enumeration Date | 12/08/2023 |
| Last Update Date | 05/13/2024 |
| Medicare PECOS PAC ID | 6406298249 |
|---|---|
| Medicare Enrollment ID | O20240524002775 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275300287 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Gregory J Matechak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851492672 PECOS PAC ID: 2769456946 Enrollment ID: I20040824000130 |
| Provider Name | Leia Dawson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376700989 PECOS PAC ID: 6608054085 Enrollment ID: I20110707000603 |
| Provider Name | Alexis Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356851406 PECOS PAC ID: 3072873512 Enrollment ID: I20210222002312 |
| Provider Name | Marjorie L Mcdermott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952083321 PECOS PAC ID: 1759744402 Enrollment ID: I20230828003159 |
| Provider Name | Elleni D Kebede |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124711064 PECOS PAC ID: 8729433305 Enrollment ID: I20231017003163 |
Proactive Physicians Of Marietta, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 790 Church St Ne, Suite 220, Marietta, GA 30060 Phone: 678-753-9300 Fax: 678-753-9300 | |
Premise Health Of Georgia Medical, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 86 South Cobb Drive Mail Drop 0454, Marietta, GA 30063 Phone: 770-494-4131 Fax: 770-494-7490 | |
Clifford Family Practice Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1355 Church Street Ext Ne Ste G, Marietta, GA 30060 Phone: 678-388-1355 Fax: 770-422-1416 | |
Saint Joseph's Mercy Care Services, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1407 Cobb Parkway Nw, Marietta, GA 30060 Phone: 678-843-8600 | |
Epitome Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 631 Campbell Hill St Nw Ste 200, Marietta, GA 30060 Phone: 770-727-6124 | |
Wellstar East Cobb Medical Center, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1010 Johnson Ferry Rd, Marietta, GA 30068 Phone: 770-579-7900 Fax: 770-579-7962 |