| Willie E Landrum Ii Md Pc | |
|
705 Juniper St Ne Atlanta GA 30308-1307 | |
| (678) 542-7256 | |
| (404) 963-7620 |
| Full Name | Willie E Landrum Ii Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 705 Juniper St Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Katrina Gill (OFFICE MANAGER) |
| Authorized Official Contact | 6784626101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willie E Landrum Ii Md Pc 4480 South Cobb Drive Ste H Box 368 Smyrna GA 30080 Ph: (678) 542-7256 | Willie E Landrum Ii Md Pc 705 Juniper St Ne Atlanta GA 30308-1307 Ph: (678) 542-7256 |
| NPI Number | 1780419614 |
|---|---|
| Provider Enumeration Date | 09/02/2024 |
| Last Update Date | 02/26/2025 |
| Medicare PECOS PAC ID | 4385165646 |
|---|---|
| Medicare Enrollment ID | O20250304001322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780419614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Willie Landrum |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760653612 PECOS PAC ID: 0345316949 Enrollment ID: I20080905000150 |
| Provider Name | Alexis Lavantae Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689271918 PECOS PAC ID: 1850769605 Enrollment ID: I20221129000600 |
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