Fort Valley Outpatient | |
410 E Church St Fort Valley GA 31030-3097 | |
(478) 825-6499 | |
Not Available |
Full Name | Fort Valley Outpatient |
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Speciality | Community/Behavioral Health |
Location | 410 E Church St, Fort Valley, Georgia |
Authorized Official Name and Position | Margaret Jordan (RCM MANAGER) |
Authorized Official Contact | 2298155286 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Fort Valley Outpatient Po Box 1348 Americus GA 31709-1348 Ph: (229) 815-5454 | Fort Valley Outpatient 410 E Church St Fort Valley GA 31030-3097 Ph: (478) 825-6499 |
NPI Number | 1366521932 |
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Provider Enumeration Date | 11/03/2006 |
Last Update Date | 01/29/2024 |
Certification Date | 01/29/2024 |
Medicare PECOS PAC ID | 3274426150 |
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Medicare Enrollment ID | O20040204000828 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366521932 | NPI | - | NPPES |
000604502B | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (Georgia) | Primary |
Provider Name | Jaymal R. Patel |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1962433599 PECOS PAC ID: 3779474010 Enrollment ID: I20040324000650 |
Provider Name | Marsha E Kinnett |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538110598 PECOS PAC ID: 0547238925 Enrollment ID: I20040923000143 |
Provider Name | Eric C Fan |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1629191663 PECOS PAC ID: 6507826302 Enrollment ID: I20041015000600 |
Provider Name | Michelle B Fan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1437272796 PECOS PAC ID: 6204896988 Enrollment ID: I20041018000054 |
Provider Name | Wallace D Mays |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1881667988 PECOS PAC ID: 2264474725 Enrollment ID: I20050527000005 |
Provider Name | Henry S Teaford |
---|---|
Provider Type | Practitioner - Thoracic Surgery |
Provider Identifiers | NPI Number: 1013070564 PECOS PAC ID: 0941220503 Enrollment ID: I20051129000401 |
Provider Name | Kenneth E Dinella |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1992921126 PECOS PAC ID: 8022160639 Enrollment ID: I20090713000333 |
Provider Name | Roseline A Makinde |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902108491 PECOS PAC ID: 5193904506 Enrollment ID: I20110131000831 |
Provider Name | Glendell B Coleman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1962755421 PECOS PAC ID: 4688826514 Enrollment ID: I20121128000649 |
Provider Name | Cornelius C Grimes |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1710265145 PECOS PAC ID: 2062664709 Enrollment ID: I20121204000362 |
Provider Name | Daniela L Torres |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104232941 PECOS PAC ID: 7719107028 Enrollment ID: I20141009001101 |
Provider Name | Nurul I Hoque |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1912109505 PECOS PAC ID: 2163597170 Enrollment ID: I20150708000183 |
Provider Name | Michael Barrow |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497111207 PECOS PAC ID: 2062716723 Enrollment ID: I20160202001326 |
Provider Name | Michayala K Bush |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1396288684 PECOS PAC ID: 1355625062 Enrollment ID: I20170224000502 |
Provider Name | Megan W Alligood |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225534670 PECOS PAC ID: 9335499292 Enrollment ID: I20180913003429 |
Provider Name | Sheldon Brown |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1972985273 PECOS PAC ID: 8527376524 Enrollment ID: I20190814002780 |
Provider Name | Danielle A Andrews |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1578081618 PECOS PAC ID: 2961769526 Enrollment ID: I20190827002563 |
Provider Name | Marlanea Jarrell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013501857 PECOS PAC ID: 3678973476 Enrollment ID: I20210616001271 |
Provider Name | Kathleen A Yngayo |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386251452 PECOS PAC ID: 0941682892 Enrollment ID: I20220809001852 |
Provider Name | Deepa Sobti |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1124058458 PECOS PAC ID: 3577564566 Enrollment ID: I20220822001183 |
Provider Name | Chiamaka J Anosike |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407594757 PECOS PAC ID: 5597132514 Enrollment ID: I20221104000330 |
Provider Name | Kiana Yvette Johnson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811630544 PECOS PAC ID: 4284084203 Enrollment ID: I20240103000294 |
Provider Name | Benjamin Gatliff |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1316276645 PECOS PAC ID: 3779924071 Enrollment ID: I20240517001730 |
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