| Momentum Primary Care | |
|
120 Handley Rd #400 Tyrone GA 30290-2177 | |
| (404) 597-9523 | |
| Not Available |
| Full Name | Momentum Primary Care |
|---|---|
| Speciality | Clinic/center - Urgent Care |
| Location | 120 Handley Rd, Tyrone, Georgia |
| Authorized Official Name and Position | Jared Deraney (OWNER) |
| Authorized Official Contact | 4804820934 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Momentum Primary Care Po Box 935719 Atlanta GA 31193-2177 Ph: (678) 430-8478 | Momentum Primary Care 120 Handley Rd #400 Tyrone GA 30290-2177 Ph: (404) 597-9523 |
| NPI Number | 1043612922 |
|---|---|
| Provider Enumeration Date | 09/22/2014 |
| Last Update Date | 03/26/2021 |
| Certification Date | 03/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043612922 | NPI | - | NPPES |
| 00469092A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 033776 (Georgia) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | () | Primary |
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