| Performance Pediatrics And Sports Medicine, Llc | |
|
1181 Langford Dr Bldg 200-101 Bogart GA 30622-2542 | |
| (706) 207-6694 | |
| Not Available |
| Full Name | Performance Pediatrics And Sports Medicine, Llc |
|---|---|
| Speciality | Pediatrics - Sports Medicine |
| Location | 1181 Langford Dr, Bogart, Georgia |
| Authorized Official Name and Position | Tara Ann Merritt (OWNER PHYSICIAN) |
| Authorized Official Contact | 7062023236 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Performance Pediatrics And Sports Medicine, Llc 1181 Langford Dr Bldg 200-101 Bogart GA 30622-2542 Ph: () - | Performance Pediatrics And Sports Medicine, Llc 1181 Langford Dr Bldg 200-101 Bogart GA 30622-2542 Ph: (706) 207-6694 |
| NPI Number | 1295081321 |
|---|---|
| Provider Enumeration Date | 07/26/2012 |
| Last Update Date | 07/26/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295081321 | NPI | - | NPPES |
| 58543 | Other | GA | STATE MEDICAL LICENSE |
| 003125239A | Medicaid | GA | |
| 489449582C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 58543 (Georgia) | Secondary |
| 208000000X | Pediatrics | 58543 (Georgia) | Secondary |
| 2080S0010X | Pediatrics - Sports Medicine | 58543 (Georgia) | Primary |
Oconee Family Practice, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1747 Langford Dr Bldg 400-105, Bogart, GA 30622 Phone: 706-769-1100 Fax: 706-310-9847 | |
Athens Regional Physician Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1181 Langford Dr, Bldg 100 Ste 101, Bogart, GA 30622 Phone: 706-546-9838 Fax: 706-546-9347 | |
Traditions Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1561 Lenru Rd Ste A, Bogart, GA 30622 Phone: 770-725-2399 |