| |
1601 Watson Blvd Warner Robins GA 31093 | |
(478) 922-4281 | |
(478) 322-5174 |
Full Name | |
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Speciality | General Acute Care Hospital |
Location | 1601 Watson Blvd, Warner Robins, Georgia |
Authorized Official Name and Position | Sean Whilden (CFO) |
Authorized Official Contact | 4783524306 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1601 Watson Blvd Warner Robins GA 31093 Ph: (478) 922-4281 | 1601 Watson Blvd Warner Robins GA 31093 Ph: (478) 922-4281 |
NPI Number | 1962435792 |
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Provider Enumeration Date | 07/07/2006 |
Last Update Date | 01/26/2022 |
Certification Date | 01/26/2022 |
Medicare PECOS PAC ID | 9234029729 |
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Medicare Enrollment ID | O20040318000314 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962435792 | NPI | - | NPPES |
000000976A | Medicaid | GA | |
222 | Other | GA | BLUE CROSS PROV NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
273R00000X | Psychiatric Unit | 076-656 (Georgia) | Secondary |
282N00000X | General Acute Care Hospital | 076-656 (Georgia) | Primary |
Provider Name | Ferial Walid |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1750486742 PECOS PAC ID: 6103867205 Enrollment ID: I20050519000127 |
Provider Name | Richard Lyndon Smith |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1023043130 PECOS PAC ID: 2668642349 Enrollment ID: I20110907001426 |
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