| Delta Comprehensive Injury And Wellness Center Llc | |
|
1790 Mulkey Rd Ste 1314 Austell GA 30106-1122 | |
| (770) 284-3832 | |
| Not Available |
| Full Name | Delta Comprehensive Injury And Wellness Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1790 Mulkey Rd Ste 1314, Austell, Georgia |
| Authorized Official Name and Position | Jose Marti (OWNER) |
| Authorized Official Contact | 6784013033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Delta Comprehensive Injury And Wellness Center Llc 1790 Mulkey Rd Ste 1314 Austell GA 30106-1122 Ph: () - | Delta Comprehensive Injury And Wellness Center Llc 1790 Mulkey Rd Ste 1314 Austell GA 30106-1122 Ph: (770) 284-3832 |
| NPI Number | 1124742218 |
|---|---|
| Provider Enumeration Date | 10/03/2022 |
| Last Update Date | 06/30/2023 |
| Medicare PECOS PAC ID | 4284095175 |
|---|---|
| Medicare Enrollment ID | O20230725000953 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124742218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Provider Name | Venu M Madhipatla |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1578623278 PECOS PAC ID: 0941305452 Enrollment ID: I20220810003934 |
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