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775 West Ave Suite A Cartersville GA 30120-3481 | |
| (770) 887-1668 | |
| (770) 887-3462 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 775 West Ave, Cartersville, Georgia |
| Authorized Official Name and Position | Todd Shifflet (CEO) |
| Authorized Official Contact | 7708871668 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 307 Cumming GA 30028-0307 Ph: (770) 887-1668 | 775 West Ave Suite A Cartersville GA 30120-3481 Ph: (770) 887-1668 |
| NPI Number | 1407281058 |
|---|---|
| Provider Enumeration Date | 09/13/2013 |
| Last Update Date | 05/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407281058 | NPI | - | NPPES |
| 300022400A | Medicaid | GA | |
| 003146289A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Georgia) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
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