Organization
PIEDMONT PROVIDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTY AQUINO (DIRECTOR, PROVIDER ENROLLMENT)
(470) 271-3427
Entity
Organization
Contact information
Practice address
220 J L WHITE DR STE 120, JASPER, GA 30143-4894
(770) 801-2500
(770) 803-2121
Mailing address
PO BOX 102321, ATLANTA, GA 30368-2321
(770) 801-2500
(770) 803-2121
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
306264909A
—
GA
01
—
CH4995
RR MEDICARE
GA
01
—
GRP3809
MEDICARE
GA
Enumeration date
08/14/2006
Last updated
10/26/2021
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