| Ball Ground Family Practice,p.c. | |
|
91 Sammy Mcghee Blvd Suite 101 Jasper GA 30143-7703 | |
| (706) 253-6200 | |
| (706) 253-6276 |
| Full Name | Ball Ground Family Practice,p.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 91 Sammy Mcghee Blvd, Jasper, Georgia |
| Authorized Official Name and Position | Charles Leo Coster (PHYSICIAN) |
| Authorized Official Contact | 7062536200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ball Ground Family Practice,p.c. 91 Sammy Mcghee Blvd Suite 101 Jasper GA 30143-7703 Ph: (706) 253-6200 | Ball Ground Family Practice,p.c. 91 Sammy Mcghee Blvd Suite 101 Jasper GA 30143-7703 Ph: (706) 253-6200 |
| NPI Number | 1275799322 |
|---|---|
| Provider Enumeration Date | 07/29/2008 |
| Last Update Date | 10/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275799322 | NPI | - | NPPES |
| 000797945A | Medicaid | GA | |
| 000797948A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 045754 (Georgia) | Primary |
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