| Living Well Primary Care, Llc | |
|
12460 Crabapple Rd Ste 202-313 Alpharetta GA 30004-6602 | |
| (404) 819-7660 | |
| (404) 393-7788 |
| Full Name | Living Well Primary Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12460 Crabapple Rd Ste 202-313, Alpharetta, Georgia |
| Authorized Official Name and Position | Lee Pennington Mcnichols (OWNER/MANAGING MEMBER) |
| Authorized Official Contact | 4048197660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Well Primary Care, Llc 12460 Crabapple Rd Ste 202-313 Alpharetta GA 30004-6602 Ph: (404) 819-7660 | Living Well Primary Care, Llc 12460 Crabapple Rd Ste 202-313 Alpharetta GA 30004-6602 Ph: (404) 819-7660 |
| NPI Number | 1013640242 |
|---|---|
| Provider Enumeration Date | 07/06/2022 |
| Last Update Date | 07/06/2022 |
| Medicare PECOS PAC ID | 5799169777 |
|---|---|
| Medicare Enrollment ID | O20220825002507 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013640242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Faye Vargas Morris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194707398 PECOS PAC ID: 9830186279 Enrollment ID: I20090211000768 |
| Provider Name | Lee Pennington Mcnichols |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376034983 PECOS PAC ID: 0648522425 Enrollment ID: I20181005000000 |
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