Pineland Mhmrsa | |
5 W Altman St Statesboro GA 30458-5212 | |
(912) 764-6906 | |
(912) 764-6466 |
Full Name | Pineland Mhmrsa |
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Speciality | Community/Behavioral Health |
Location | 5 W Altman St, Statesboro, Georgia |
Authorized Official Name and Position | June A. Dipolito (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 9127646906 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Pineland Mhmrsa Po Box 745 5 West Altman Street Statesboro GA 30459-0745 Ph: (912) 764-6906 | Pineland Mhmrsa 5 W Altman St Statesboro GA 30458-5212 Ph: (912) 764-6906 |
NPI Number | 1588735252 |
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Provider Enumeration Date | 11/13/2006 |
Last Update Date | 09/18/2007 |
Medicare PECOS PAC ID | 6002898616 |
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Medicare Enrollment ID | O20040607000175 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588735252 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Provider Name | Michael A Williams |
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Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1376504647 PECOS PAC ID: 9032015110 Enrollment ID: I20031210000006 |
Provider Name | Ivy L Shuman |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1881693380 PECOS PAC ID: 6103818612 Enrollment ID: I20040402000147 |
Provider Name | Joel S Bray |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457467219 PECOS PAC ID: 8729082037 Enrollment ID: I20060829000157 |
Provider Name | Thomas M Amburgey |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1841254976 PECOS PAC ID: 1658409420 Enrollment ID: I20100514000782 |
Provider Name | Reemon Bishara |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1750308623 PECOS PAC ID: 0042203606 Enrollment ID: I20101207000975 |
Provider Name | Jennfier H Gray |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083962849 PECOS PAC ID: 0749432110 Enrollment ID: I20121211000115 |
Provider Name | Michael E Daly |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659748077 PECOS PAC ID: 7012226822 Enrollment ID: I20151019000642 |
Provider Name | Marianne A Mainer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861868481 PECOS PAC ID: 8426367061 Enrollment ID: I20151021001052 |
Provider Name | Qian Tang |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033657333 PECOS PAC ID: 3274817382 Enrollment ID: I20170308001564 |
Provider Name | Swaroop Reddy |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1235363581 PECOS PAC ID: 7416285119 Enrollment ID: I20190819003888 |
Provider Name | Alana P Waters |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1174000509 PECOS PAC ID: 5496129405 Enrollment ID: I20230314002504 |
Provider Name | Mandeep Singh |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1881219145 PECOS PAC ID: 3274958947 Enrollment ID: I20230330000076 |
Provider Name | Nafiz K Sheikh |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1740805852 PECOS PAC ID: 8921422833 Enrollment ID: I20230501002923 |
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