| Epitome Primary Care | |
|
631 Campbell Hill St Nw Ste 200 Marietta GA 30060-1390 | |
| (770) 727-6124 | |
| Not Available |
| Full Name | Epitome Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 631 Campbell Hill St Nw Ste 200, Marietta, Georgia |
| Authorized Official Name and Position | Kenette St-gourdin (OWNER) |
| Authorized Official Contact | 9126956080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Epitome Primary Care 631 Campbell Hill St Nw Ste 200 Marietta GA 30060-1390 Ph: (770) 727-6124 | Epitome Primary Care 631 Campbell Hill St Nw Ste 200 Marietta GA 30060-1390 Ph: (770) 727-6124 |
| NPI Number | 1023835782 |
|---|---|
| Provider Enumeration Date | 09/24/2024 |
| Last Update Date | 12/04/2024 |
| Certification Date | 12/04/2024 |
| Medicare PECOS PAC ID | 0042747917 |
|---|---|
| Medicare Enrollment ID | O20241217003125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023835782 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Windsor Pamphile |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700048188 PECOS PAC ID: 0648449736 Enrollment ID: I20110805000494 |
| Provider Name | Kenette St-gourdin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619506557 PECOS PAC ID: 1153768072 Enrollment ID: I20250213001292 |
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