| Northeast Family Practice P.c | |
|
4720 Peachtree Industrial Blvd Ste 202 Norcross GA 30071-5735 | |
| (770) 514-8880 | |
| Not Available |
| Full Name | Northeast Family Practice P.c |
|---|---|
| Speciality | Clinic/Center |
| Location | 4720 Peachtree Industrial Blvd, Norcross, Georgia |
| Authorized Official Name and Position | Regina Jianhua Wang (PRESIDENT) |
| Authorized Official Contact | 4048197261 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Family Practice P.c 4720 Peachtree Industrial Blvd Ste 202 Norcross GA 30071-5735 Ph: (770) 514-8880 | Northeast Family Practice P.c 4720 Peachtree Industrial Blvd Ste 202 Norcross GA 30071-5735 Ph: (770) 514-8880 |
| NPI Number | 1396099578 |
|---|---|
| Provider Enumeration Date | 11/09/2012 |
| Last Update Date | 11/09/2012 |
| Medicare PECOS PAC ID | 8426201294 |
|---|---|
| Medicare Enrollment ID | O20130102000279 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396099578 | NPI | - | NPPES |
| 00951475A | Medicaid | GA | |
| 08BBWJW | Other | GA | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 050568 (Georgia) | Primary |
| Provider Name | Regina J Wang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073504643 PECOS PAC ID: 6103964242 Enrollment ID: I20091111000222 |
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