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235 E Washington Ave Ashburn GA 31714-5224 | |
(229) 484-2300 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 235 E Washington Ave, Ashburn, Georgia |
Authorized Official Name and Position | Amanda Chavers (DIRECTOR OF NURSING) |
Authorized Official Contact | 2294842300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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235 E Washington Ave Ashburn GA 31714-5224 Ph: () - | 235 E Washington Ave Ashburn GA 31714-5224 Ph: (229) 484-2300 |
NPI Number | 1194305680 |
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Provider Enumeration Date | 04/09/2021 |
Last Update Date | 07/15/2021 |
Medicare PECOS PAC ID | 2769883396 |
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Medicare Enrollment ID | O20210702000404 |
Identifier | Type | State | Issuer |
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1194305680 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Susan R Ethridge |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1316922206 PECOS PAC ID: 2769371079 Enrollment ID: I20040315000119 |
Provider Name | Joseph Morgan Jackson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1811980352 PECOS PAC ID: 5092847202 Enrollment ID: I20100722000795 |
Chl Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 235 E Washington Ave, Ashburn, GA 31714 Phone: 229-778-9216 |