| Graceol Corporation | |
|
1035 Honey Creek Rd Conyers GA 30013 | |
| (404) 839-2688 | |
| (770) 922-9498 |
| Full Name | Graceol Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 1035 Honey Creek Rd, Conyers, Georgia |
| Authorized Official Name and Position | Yemi J. Sowemimo (OWNER) |
| Authorized Official Contact | 4048392688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Graceol Corporation 1035 Honey Creek Road Conyers GA 30013 Ph: (404) 839-2688 | Graceol Corporation 1035 Honey Creek Rd Conyers GA 30013 Ph: (404) 839-2688 |
| NPI Number | 1306373188 |
|---|---|
| Provider Enumeration Date | 05/11/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 2163784455 |
|---|---|
| Medicare Enrollment ID | O20180327000258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306373188 | NPI | - | NPPES |
| 1639177066 | Other | GA | NPI |
| 1912016411 | Other | NY | NPI |
| 1790107381 | Other | GA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Yemi J Sowemimo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790107381 PECOS PAC ID: 6800157868 Enrollment ID: I20180308000468 |
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