| Kcp Enterprises | |
|
1568 Southlake Pkwy Ste C Morrow GA 30260 | |
| (470) 878-0696 | |
| Not Available |
| Full Name | Kcp Enterprises |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 1568 Southlake Pkwy Ste C, Morrow, Georgia |
| Authorized Official Name and Position | Emma C Cull (COO) |
| Authorized Official Contact | 6784695011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kcp Enterprises 1568 Southlake Pkwy Ste C Morrow GA 30260-4153 Ph: (470) 878-0696 | Kcp Enterprises 1568 Southlake Pkwy Ste C Morrow GA 30260 Ph: (470) 878-0696 |
| NPI Number | 1043679418 |
|---|---|
| Provider Enumeration Date | 02/15/2016 |
| Last Update Date | 12/09/2025 |
| Medicare PECOS PAC ID | 7517303613 |
|---|---|
| Medicare Enrollment ID | O20240312001492 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043679418 | NPI | - | NPPES |
| Provider Name | Sendhil Subramanian |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1902883168 PECOS PAC ID: 4981516689 Enrollment ID: I20040728000877 |
| Provider Name | Cornell Peters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861487225 PECOS PAC ID: 1557492758 Enrollment ID: I20100702000437 |
| Provider Name | Victor Osisanya |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1679884753 PECOS PAC ID: 8628393451 Enrollment ID: I20150218002209 |
| Provider Name | Sheimeita Chance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144692500 PECOS PAC ID: 5092012880 Enrollment ID: I20160322001125 |
| Provider Name | Vandy Gaffney |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1730470329 PECOS PAC ID: 3274776869 Enrollment ID: I20170509001065 |
| Provider Name | Anslie Prudhomme |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285126391 PECOS PAC ID: 9234574641 Enrollment ID: I20240226001094 |
Medcare Plus Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1404 Southlake Plaza Dr, Morrow, GA 30260 Phone: 404-436-1876 Fax: 888-720-2672 | |
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