| Med Fast Pc | |
|
902 Athens Hwy Loganville GA 30052-4904 | |
| (770) 554-5533 | |
| (770) 554-8129 |
| Full Name | Med Fast Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 902 Athens Hwy, Loganville, Georgia |
| Authorized Official Name and Position | Elizabeth Mikrut (PRESIDENT) |
| Authorized Official Contact | 7705545533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Med Fast Pc 902 Athens Hwy Loganville GA 30052-4904 Ph: (770) 554-5533 | Med Fast Pc 902 Athens Hwy Loganville GA 30052-4904 Ph: (770) 554-5533 |
| NPI Number | 1487849857 |
|---|---|
| Provider Enumeration Date | 09/10/2007 |
| Last Update Date | 09/21/2007 |
| Medicare PECOS PAC ID | 9133118490 |
|---|---|
| Medicare Enrollment ID | O20040511000870 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487849857 | NPI | - | NPPES |
| GRP6328 | Other | GA | MEDICARE GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 29730 (Georgia) | Primary |
| Provider Name | Elizabeth Z Mikrut |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760530778 PECOS PAC ID: 0941299218 Enrollment ID: I20041021000582 |
| Provider Name | Irene Ristic |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649316464 PECOS PAC ID: 5597848291 Enrollment ID: I20080218000461 |
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