Organization
LONGEVITY CLINICAL LTC ASSOCIATES OF GEORGIA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE L VINCUR (LWC PRACTICE MANAGER)
(561) 815-2427
Entity
Organization
Contact information
Practice address
1040 CROWN POINTE PKWY STE 600, ATLANTA, GA 30338-4741
(561) 815-2427
Mailing address
11780 US HIGHWAY 1 STE N107, NORTH PALM BEACH, FL 33408-3007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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