| Mountain Lakes Physicians Group | |
|
338 Stage Coach Dr Clayton GA 30525-3586 | |
| (706) 782-3100 | |
| Not Available |
| Full Name | Mountain Lakes Physicians Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 338 Stage Coach Dr, Clayton, Georgia |
| Authorized Official Name and Position | Kristy Hall (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7067820400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Lakes Physicians Group 162 Legacy Pt Clayton GA 30525-5354 | Mountain Lakes Physicians Group 338 Stage Coach Dr Clayton GA 30525-3586 Ph: (706) 782-3100 |
| NPI Number | 1386339141 |
|---|---|
| Provider Enumeration Date | 04/07/2023 |
| Last Update Date | 06/12/2026 |
| Certification Date | 06/12/2026 |
| Medicare PECOS PAC ID | 1052342854 |
|---|---|
| Medicare Enrollment ID | O20230501002685 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386339141 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | () | Primary |
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