| Healing Oaks Llc | |
|
203 Oakside Ln Ste C Canton GA 30114-6407 | |
| (770) 604-1930 | |
| (770) 604-1929 |
| Full Name | Healing Oaks Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 203 Oakside Ln Ste C, Canton, Georgia |
| Authorized Official Name and Position | Sheryl B Vickery (OWNER/MANAGER) |
| Authorized Official Contact | 7703780328 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Oaks Llc Po Box 5554 Canton GA 30114-0290 Ph: (770) 378-0328 | Healing Oaks Llc 203 Oakside Ln Ste C Canton GA 30114-6407 Ph: (770) 604-1930 |
| NPI Number | 1649856493 |
|---|---|
| Provider Enumeration Date | 03/22/2021 |
| Last Update Date | 03/22/2021 |
| Medicare PECOS PAC ID | 5193127827 |
|---|---|
| Medicare Enrollment ID | O20210716001757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649856493 | NPI | - | NPPES |
| 773092643F | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Sheryl A Vickery |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538226220 PECOS PAC ID: 6800884115 Enrollment ID: I20040505000383 |
| Provider Name | Meera Thirumal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629759071 PECOS PAC ID: 1658724521 Enrollment ID: I20240126001808 |
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