| Longevity Clinical Ltc Associates Of Georgia, Pc | |
|
1040 Crown Pointe Pkwy Ste 600 Atlanta GA 30338-4741 | |
| (561) 815-2427 | |
| Not Available |
| Full Name | Longevity Clinical Ltc Associates Of Georgia, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1040 Crown Pointe Pkwy Ste 600, Atlanta, Georgia |
| Authorized Official Name and Position | Diane L Vincur (LWC PRACTICE MANAGER) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Clinical Ltc Associates Of Georgia, Pc 11780 Us Highway 1 Ste N107 North Palm Beach FL 33408-3007 Ph: () - | Longevity Clinical Ltc Associates Of Georgia, Pc 1040 Crown Pointe Pkwy Ste 600 Atlanta GA 30338-4741 Ph: (561) 815-2427 |
| NPI Number | 1699469668 |
|---|---|
| Provider Enumeration Date | 06/05/2023 |
| Last Update Date | 06/05/2023 |
| Medicare PECOS PAC ID | 1759745847 |
|---|---|
| Medicare Enrollment ID | O20230907002528 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699469668 | NPI | - | NPPES |
| Provider Name | Eileen O'hara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831240712 PECOS PAC ID: 3072744721 Enrollment ID: I20210114001517 |
| Provider Name | Waseem Ghannam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306080510 PECOS PAC ID: 5092971085 Enrollment ID: I20230907002910 |
| Provider Name | Robin Stone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598912206 PECOS PAC ID: 1951696830 Enrollment ID: I20230912003635 |
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