| Eagle's Landing Longevity Center | |
|
1325 Rock Quarry Rd Suite 200 Stockbridge GA 30281-5088 | |
| (770) 389-0734 | |
| (770) 389-5364 |
| Full Name | Eagle's Landing Longevity Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 1325 Rock Quarry Rd, Stockbridge, Georgia |
| Authorized Official Name and Position | Gayla Deneice Sylvain (OWNER) |
| Authorized Official Contact | 7703890734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle's Landing Longevity Center 1325 Rock Quarry Rd Suite 200 Stockbridge GA 30281-5088 Ph: (770) 389-0734 | Eagle's Landing Longevity Center 1325 Rock Quarry Rd Suite 200 Stockbridge GA 30281-5088 Ph: (770) 389-0734 |
| NPI Number | 1134524788 |
|---|---|
| Provider Enumeration Date | 10/24/2014 |
| Last Update Date | 02/24/2020 |
| Medicare PECOS PAC ID | 2860776242 |
|---|---|
| Medicare Enrollment ID | O20170302001746 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134524788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 39958 (Georgia) | Primary |
| Provider Name | Gayla D Sylvain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104925106 PECOS PAC ID: 6002889821 Enrollment ID: I20040818001064 |
| Provider Name | Angelique S Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598160046 PECOS PAC ID: 5698091130 Enrollment ID: I20150227001763 |
| Provider Name | Noellemarie A Barrera |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720224850 PECOS PAC ID: 2668597832 Enrollment ID: I20170510000040 |
| Provider Name | Miltonia M Woluchem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124086020 PECOS PAC ID: 3971581992 Enrollment ID: I20180613003323 |
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