| Mountain Lakes Medical Group | |
|
180 Legacy Point Suite 201 Clayton GA 30525 | |
| (706) 782-3100 | |
| Not Available |
| Full Name | Mountain Lakes Medical Group |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 180 Legacy Point, Clayton, Georgia |
| Authorized Official Name and Position | Matthew Lemak (CEO) |
| Authorized Official Contact | 2053297501 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Lakes Medical Group 162 Legacy Pt Clayton GA 30525-5354 | Mountain Lakes Medical Group 180 Legacy Point Suite 201 Clayton GA 30525 Ph: (706) 782-3100 |
| NPI Number | 1972116630 |
|---|---|
| Provider Enumeration Date | 08/24/2020 |
| Last Update Date | 08/18/2022 |
| Certification Date | 08/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972116630 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
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