| Lillette A Intaphan Md Llc | |
|
432 Poplar St Suite B Macon GA 31201-3336 | |
| (478) 475-1299 | |
| (478) 405-7928 |
| Full Name | Lillette A Intaphan Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 432 Poplar St, Macon, Georgia |
| Authorized Official Name and Position | Lillette A Intaphan (MDC) |
| Authorized Official Contact | 4784751299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lillette A Intaphan Md Llc Po Box 26040 Macon GA 31221-6040 Ph: (478) 475-1299 | Lillette A Intaphan Md Llc 432 Poplar St Suite B Macon GA 31201-3336 Ph: (478) 475-1299 |
| NPI Number | 1649414657 |
|---|---|
| Provider Enumeration Date | 04/22/2009 |
| Last Update Date | 10/19/2009 |
| Medicare PECOS PAC ID | 8325199862 |
|---|---|
| Medicare Enrollment ID | O20090624000122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649414657 | NPI | - | NPPES |
| DP2683 | Other | GA | RR MDC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 033601 (Georgia) | Primary |
| Provider Name | Lillette Intaphan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487699773 PECOS PAC ID: 6406757582 Enrollment ID: I20080310000164 |
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New Chance Centers Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2733 Sheraton Dr Ste 110, Macon, GA 31204 Phone: 478-202-7273 Fax: 478-239-0094 | |
Coliseum Health Group, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 420 Charter Blvd, Suite 304, Macon, GA 31210 Phone: 478-405-0280 | |
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