| The East Clinic, Llc | |
|
539 Hardee St Dallas GA 30132-4711 | |
| (770) 505-0531 | |
| (770) 485-0570 |
| Full Name | The East Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 539 Hardee St, Dallas, Georgia |
| Authorized Official Name and Position | Mary J East (OWNER/PHYSICIAN) |
| Authorized Official Contact | 7705050531 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The East Clinic, Llc 539 Hardee St Dallas GA 30132-4711 Ph: (770) 505-0531 | The East Clinic, Llc 539 Hardee St Dallas GA 30132-4711 Ph: (770) 505-0531 |
| NPI Number | 1831563261 |
|---|---|
| Provider Enumeration Date | 11/23/2015 |
| Last Update Date | 12/03/2015 |
| Medicare PECOS PAC ID | 1557662699 |
|---|---|
| Medicare Enrollment ID | O20151215002341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831563261 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 63187 (Georgia) | Primary |
| Provider Name | Mary Jean East |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225091341 PECOS PAC ID: 8820124431 Enrollment ID: I20100407000063 |
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