| Phoenix Medical Office At College Park,llc | |
|
1631 Phoenix Blvd Ste 4 College Park GA 30349-5545 | |
| (678) 788-8950 | |
| (678) 788-8953 |
| Full Name | Phoenix Medical Office At College Park,llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1631 Phoenix Blvd Ste 4, College Park, Georgia |
| Authorized Official Name and Position | Kelvin Maurice Hamner (OWNER/MD) |
| Authorized Official Contact | 6787888950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Medical Office At College Park,llc 1631 Phoenix Blvd Ste 4 College Park GA 30349-5545 Ph: (678) 788-8950 | Phoenix Medical Office At College Park,llc 1631 Phoenix Blvd Ste 4 College Park GA 30349-5545 Ph: (678) 788-8950 |
| NPI Number | 1396033064 |
|---|---|
| Provider Enumeration Date | 07/15/2011 |
| Last Update Date | 12/11/2012 |
| Medicare PECOS PAC ID | 2466622881 |
|---|---|
| Medicare Enrollment ID | O20110823000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396033064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 39813 (Georgia) | Primary |
| Provider Name | Kelvin Hamner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073656344 PECOS PAC ID: 8426182155 Enrollment ID: I20100817001289 |
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