| Waterfalls Medical Practice, P.c | |
|
112 Governors Sq Ste B Peachtree City GA 30269-4864 | |
| (678) 932-8112 | |
| (678) 932-8113 |
| Full Name | Waterfalls Medical Practice, P.c |
|---|---|
| Speciality | Internal Medicine |
| Location | 112 Governors Sq Ste B, Peachtree City, Georgia |
| Authorized Official Name and Position | Irene Ayoyinka Omotoso (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6789328112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waterfalls Medical Practice, P.c 1202 Tolmount Ct Peachtree City GA 30269-3348 Ph: (678) 932-8112 | Waterfalls Medical Practice, P.c 112 Governors Sq Ste B Peachtree City GA 30269-4864 Ph: (678) 932-8112 |
| NPI Number | 1225567225 |
|---|---|
| Provider Enumeration Date | 06/05/2017 |
| Last Update Date | 06/16/2020 |
| Medicare PECOS PAC ID | 4284904327 |
|---|---|
| Medicare Enrollment ID | O20170721001168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225567225 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 053629 (Georgia) | Primary |
| Provider Name | Irene Ayoyinka Omotoso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205848785 PECOS PAC ID: 6608765193 Enrollment ID: I20050509000621 |
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