| Midnight Rose, Llc | |
|
6380 Bells Ferry Rd Ste 107 Acworth GA 30102-5435 | |
| (404) 835-0827 | |
| Not Available |
| Full Name | Midnight Rose, Llc |
|---|---|
| Speciality | General Practice |
| Location | 6380 Bells Ferry Rd Ste 107, Acworth, Georgia |
| Authorized Official Name and Position | Christina Abernathy (CHIEF OPERATIONS OFFICER) |
| Authorized Official Contact | 4048350827 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midnight Rose, Llc 6380 Bells Ferry Rd Ste 107 Acworth GA 30102-5435 Ph: (404) 835-0827 | Midnight Rose, Llc 6380 Bells Ferry Rd Ste 107 Acworth GA 30102-5435 Ph: (404) 835-0827 |
| NPI Number | 1386260131 |
|---|---|
| Provider Enumeration Date | 06/17/2020 |
| Last Update Date | 12/03/2020 |
| Medicare PECOS PAC ID | 7214352483 |
|---|---|
| Medicare Enrollment ID | O20200805000549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386260131 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Joann Donaldson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144255399 PECOS PAC ID: 9032113626 Enrollment ID: I20060913000414 |
| Provider Name | Scott C Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417963026 PECOS PAC ID: 9638274178 Enrollment ID: I20070412000103 |
| Provider Name | Julia M Thorne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013227719 PECOS PAC ID: 1153518238 Enrollment ID: I20101215000679 |
| Provider Name | Carroll G Odem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144224957 PECOS PAC ID: 0143289249 Enrollment ID: I20180906003344 |
| Provider Name | Wenqiu Jennings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285240069 PECOS PAC ID: 0042601114 Enrollment ID: I20211228000766 |
| Provider Name | Ajibola Babatunde |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1629573936 PECOS PAC ID: 0143570770 Enrollment ID: I20230522002010 |
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