| Proactive Physicians Of Marietta, Pc | |
|
790 Church St Ne Suite 220 Marietta GA 30060-7282 | |
| (678) 753-9300 | |
| (678) 753-9300 |
| Full Name | Proactive Physicians Of Marietta, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 790 Church St Ne, Marietta, Georgia |
| Authorized Official Name and Position | Richard Scott Mills (COO) |
| Authorized Official Contact | 6787942216 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Physicians Of Marietta, Pc 790 Church St Ne Suite 220 Marietta GA 30060-7282 Ph: (678) 753-9300 | Proactive Physicians Of Marietta, Pc 790 Church St Ne Suite 220 Marietta GA 30060-7282 Ph: (678) 753-9300 |
| NPI Number | 1003356361 |
|---|---|
| Provider Enumeration Date | 03/06/2017 |
| Last Update Date | 03/06/2017 |
| Medicare PECOS PAC ID | 2961773791 |
|---|---|
| Medicare Enrollment ID | O20170811002382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003356361 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Richard L Griffith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528050838 PECOS PAC ID: 1759350671 Enrollment ID: I20041001000681 |
| Provider Name | Richard S Mills |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407848716 PECOS PAC ID: 8022087949 Enrollment ID: I20041004000414 |
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