| Medical Weight Loss & Family Practice | |
|
2280 Salem Rd Se Suite 102 Conyers GA 30013-2003 | |
| (770) 860-8860 | |
| (770) 860-8890 |
| Full Name | Medical Weight Loss & Family Practice |
|---|---|
| Speciality | General Practice |
| Location | 2280 Salem Rd Se, Conyers, Georgia |
| Authorized Official Name and Position | Vanessa Denise Gross (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 7708608860 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Weight Loss & Family Practice 2280 Salem Rd Se Suite 102 Conyers GA 30013-2003 Ph: (770) 860-8860 | Medical Weight Loss & Family Practice 2280 Salem Rd Se Suite 102 Conyers GA 30013-2003 Ph: (770) 860-8860 |
| NPI Number | 1285814491 |
|---|---|
| Provider Enumeration Date | 11/06/2007 |
| Last Update Date | 01/10/2013 |
| Medicare PECOS PAC ID | 5395714299 |
|---|---|
| Medicare Enrollment ID | O20040928000539 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285814491 | NPI | - | NPPES |
| GRP6702 | Other | GA | MEDICARE GROUP NUMBER ASS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Darryl S Gross |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1649228594 PECOS PAC ID: 2365411261 Enrollment ID: I20041004000510 |
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