| Back To Life Medical Group, Llc | |
|
557 Riverstone Pkwy Suite 140 Canton GA 30114-5223 | |
| (770) 345-2000 | |
| (770) 345-4524 |
| Full Name | Back To Life Medical Group, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 557 Riverstone Pkwy, Canton, Georgia |
| Authorized Official Name and Position | Eric A Cavaciuti (OWNER) |
| Authorized Official Contact | 7703452000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Back To Life Medical Group, Llc 557 Riverstone Pkwy Suite 140 Canton GA 30114-5223 Ph: (770) 345-2000 | Back To Life Medical Group, Llc 557 Riverstone Pkwy Suite 140 Canton GA 30114-5223 Ph: (770) 345-2000 |
| NPI Number | 1396987152 |
|---|---|
| Provider Enumeration Date | 03/25/2009 |
| Last Update Date | 11/10/2014 |
| Medicare PECOS PAC ID | 1658422456 |
|---|---|
| Medicare Enrollment ID | O20090707000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396987152 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 048997 (Georgia) | Primary |
| Provider Name | Satish Cuddapah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265538854 PECOS PAC ID: 7618028424 Enrollment ID: I20090707000398 |
| Provider Name | John A Sproviero |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1801178504 PECOS PAC ID: 6002088291 Enrollment ID: I20111012000412 |
| Provider Name | Jill Northover |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326338609 PECOS PAC ID: 1355513292 Enrollment ID: I20111018000790 |
| Provider Name | Veronica V Edwards |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003101064 PECOS PAC ID: 4385805902 Enrollment ID: I20120409000150 |
| Provider Name | Steven R Hammond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942569470 PECOS PAC ID: 4587829627 Enrollment ID: I20120622000403 |
| Provider Name | Douglas Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710369012 PECOS PAC ID: 4082924246 Enrollment ID: I20151030001873 |
| Provider Name | Derek Sean Scott |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1740377100 PECOS PAC ID: 6507802022 Enrollment ID: I20170407001187 |
| Provider Name | Girish Makwana |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1023193240 PECOS PAC ID: 7416841721 Enrollment ID: I20170810001684 |
| Provider Name | Aubry L Knight |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780152421 PECOS PAC ID: 8224373592 Enrollment ID: I20181214002850 |
Donna C. Haley, M.d., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 687 Marietta Hwy, Canton, GA 30114 Phone: 770-479-8040 Fax: 770-479-7871 | |
Medical Care Of Georgia, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 50 Medical Ln, Canton, GA 30114 Phone: 770-345-2300 Fax: 770-345-2330 | |
Dima Healthcare, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7768 Cumming Hwy Ste 300, Canton, GA 30115 Phone: 707-111-1111 | |
Mini-med Clinic Of North Georgia, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5113 Holly Springs Parkway, Canton, GA 30115 Phone: 470-331-3544 | |
Northcrest Family Medicine Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7768 Cumming Hwy, Suite 300, Canton, GA 30114 Phone: 770-720-2113 Fax: 770-704-7365 | |
Northside Medical Specialists Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 145 Riverstone Terrace, Suite 100, Canton, GA 30114 Phone: 770-704-9499 Fax: 770-704-9754 | |
Harmony Family Medicine, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2864 E Cherokee Dr Ste G, Canton, GA 30115 Phone: 770-704-2763 Fax: 770-704-2765 |