| Amelia Medical Care, Kingsland | |
|
1481 Hwy 40 E Kingsland GA 31548-6507 | |
| (912) 729-2821 | |
| (912) 729-2823 |
| Full Name | Amelia Medical Care, Kingsland |
|---|---|
| Speciality | Clinic/Center |
| Location | 1481 Hwy 40 E, Kingsland, Georgia |
| Authorized Official Name and Position | Daniel J. Matricia (OWNER) |
| Authorized Official Contact | 9127292821 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amelia Medical Care, Kingsland 1481 Hwy 40 E Kingsland GA 31548-6507 Ph: (912) 729-2821 | Amelia Medical Care, Kingsland 1481 Hwy 40 E Kingsland GA 31548-6507 Ph: (912) 729-2821 |
| NPI Number | 1982910048 |
|---|---|
| Provider Enumeration Date | 08/27/2010 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 1052530029 |
|---|---|
| Medicare Enrollment ID | O20140924001378 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982910048 | NPI | - | NPPES |
| 031289 | Other | GA | GA MEDICAL LICENSE |
| 1912972530 | Other | GA | NPI - MATRICIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 031289 (Georgia) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | Daniel J Matricia |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912972530 PECOS PAC ID: 7911982244 Enrollment ID: I20050202000217 |
| Provider Name | Angela D Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487858650 PECOS PAC ID: 1052481959 Enrollment ID: I20080604000409 |
| Provider Name | Cynthia D White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063932101 PECOS PAC ID: 5597010017 Enrollment ID: I20180623000153 |
| Provider Name | Denise E Moroz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467947838 PECOS PAC ID: 4082963723 Enrollment ID: I20180814001994 |
| Provider Name | Miranda King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184382137 PECOS PAC ID: 6709267164 Enrollment ID: I20220715001176 |
| Provider Name | Kristy L Gowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427467505 PECOS PAC ID: 2365984739 Enrollment ID: I20240613000603 |
Willis R Keene Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 130 N Gross Rd, Suite 205, Kingsland, GA 31548 Phone: 912-729-7332 Fax: 912-729-4307 | |
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