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195 E Tollison St Baxley GA 31513-0120 | |
| (912) 367-0435 | |
| (912) 367-0436 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 195 E Tollison St, Baxley, Georgia |
| Authorized Official Name and Position | Dale Spell (CEO) |
| Authorized Official Contact | 9123679841 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2070 Baxley GA 31515-2070 Ph: (912) 367-9841 | 195 E Tollison St Baxley GA 31513-0120 Ph: (912) 367-0435 |
| NPI Number | 1629217799 |
|---|---|
| Provider Enumeration Date | 02/13/2009 |
| Last Update Date | 06/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629217799 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 001-502 (Georgia) | Primary |
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