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415 Bonaventure Rd Thunderbolt GA 31404-3299 | |
(912) 790-6527 | |
(912) 644-7729 |
Full Name | |
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Speciality | Counselor |
Location | 415 Bonaventure Rd, Thunderbolt, Georgia |
Authorized Official Name and Position | Rachel Skinner (DIRECTOR OF REIMBURSEMENT) |
Authorized Official Contact | 9125548498 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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700 Coastal Village Dr Brunswick GA 31520-1974 Ph: (912) 554-8510 | 415 Bonaventure Rd Thunderbolt GA 31404-3299 Ph: (912) 790-6527 |
NPI Number | 1346379567 |
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Provider Enumeration Date | 03/05/2007 |
Last Update Date | 11/14/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346379567 | NPI | - | NPPES |
000714689V | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
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101Y00000X | Counselor | (* (Not Available)) | Primary |