| Gem Primary Healthcare, LLC. | |
|
175 Country Club Dr Bldg 100d Stockbridge GA 30281-7380 | |
| (678) 819-5497 | |
| (678) 601-1508 |
| Full Name | Gem Primary Healthcare, LLC. |
|---|---|
| Speciality | Clinic/Center |
| Location | 175 Country Club Dr Bldg 100d, Stockbridge, Georgia |
| Authorized Official Name and Position | Geraldine Eccleston Menchion (NP) |
| Authorized Official Contact | 4045146066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gem Primary Healthcare, LLC. 175 Country Club Dr Bldg 100d Stockbridge GA 30281-7380 Ph: (678) 819-5497 | Gem Primary Healthcare, LLC. 175 Country Club Dr Bldg 100d Stockbridge GA 30281-7380 Ph: (678) 819-5497 |
| NPI Number | 1457072647 |
|---|---|
| Provider Enumeration Date | 09/07/2022 |
| Last Update Date | 03/03/2023 |
| Certification Date | 03/03/2023 |
| Medicare PECOS PAC ID | 5496117905 |
|---|---|
| Medicare Enrollment ID | O20230816000446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457072647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Geraldine Eccleston Menchion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598403628 PECOS PAC ID: 6305208810 Enrollment ID: I20230816000736 |
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