| Psl Atca LLC | |
|
266 Nw Peacock Blvd Ste 204 Port St. Lucie FL 34986-2271 | |
| (404) 290-1029 | |
| Not Available |
| Full Name | Psl Atca LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 266 Nw Peacock Blvd Ste 204, Port St. Lucie, Florida |
| Authorized Official Name and Position | Gregory Buckley (CEO) |
| Authorized Official Contact | 4042901029 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Psl Atca LLC 890 Riverhaven Dr Suwanee GA 30024-4238 Ph: (404) 290-1029 | Psl Atca LLC 266 Nw Peacock Blvd Ste 204 Port St. Lucie FL 34986-2271 Ph: (404) 290-1029 |
| NPI Number | 1053127357 |
|---|---|
| Provider Enumeration Date | 12/10/2024 |
| Last Update Date | 12/10/2024 |
| Certification Date | 12/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053127357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Secondary |
| 133V00000X | Dietitian, Registered | (NU) | Secondary |
| 207R00000X | Internal Medicine | (NU) | Primary |
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