| Phoenix Clinic And Afterhour Care | |
|
2795 Main St W # 21 Snellville GA 30078-3164 | |
| (678) 386-2929 | |
| Not Available |
| Full Name | Phoenix Clinic And Afterhour Care |
|---|---|
| Speciality | Family Medicine |
| Location | 2795 Main St W # 21, Snellville, Georgia |
| Authorized Official Name and Position | Marie Lightbourne (OWNER) |
| Authorized Official Contact | 6783862929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Clinic And Afterhour Care 5858 Silver Ridge Dr Stone Mountain GA 30087-2322 Ph: (678) 386-2929 | Phoenix Clinic And Afterhour Care 2795 Main St W # 21 Snellville GA 30078-3164 Ph: (678) 386-2929 |
| NPI Number | 1720569403 |
|---|---|
| Provider Enumeration Date | 08/22/2018 |
| Last Update Date | 08/22/2018 |
| Medicare PECOS PAC ID | 8527317536 |
|---|---|
| Medicare Enrollment ID | O20180824001418 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720569403 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 060359 (Georgia) | Primary |
| Provider Name | Marie C Lightbourne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114104767 PECOS PAC ID: 5395884928 Enrollment ID: I20091120000149 |
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