OrganizationEagles Landing Family Practice, LlcFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address62 Kelly Rd, Mcdonough, GA 30253-6012(770) 914-0116PECOS EnrollmentBased on the most recent information from CMS, provider Eagles Landing Family Practice, Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:02 PM.Profile DetailsProvider ID1902907207Provider TypeOrganizationFull NameEagles Landing Family Practice, LlcSubpartNoEnumeration Date9/26/2006Last Updated2/6/2020Contact InformationPractice LocationPractice Address62 Kelly Rd, Mcdonough, GA 30253-6012Phone(770) 914-0116Fax(770) 914-7703Mailing LocationMailing Address62 Kelly Rd, Mcdonough, GA 30253-6012Phone(770) 914-0116Fax(770) 914-7703Authorized OfficialNameMitcham, Jeff (Coo)Phone(770) 914-0116Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense29378GeorgiaProvider IdentifiersIDDescriptionIssuerID061407DescriptionOtherIssuerBC/BS OF GA GROUPGeorgiaIDCC6012DescriptionOtherIssuerRAILROAD MEDICAREGeorgia