| Blakely Medical Group | |
|
11168 Columbia St Suite B Blakely GA 39823-3474 | |
| (229) 723-4313 | |
| (229) 723-3734 |
| Full Name | Blakely Medical Group |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 11168 Columbia St, Blakely, Georgia |
| Authorized Official Name and Position | Charles D Hightower (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2292282853 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blakely Medical Group 920 Cairo Rd Thomasville GA 31792-4255 Ph: (229) 227-5500 | Blakely Medical Group 11168 Columbia St Suite B Blakely GA 39823-3474 Ph: (229) 723-4313 |
| NPI Number | 1386675817 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 12/08/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386675817 | NPI | - | NPPES |
| 11D0265994 | Other | CLIA | |
| 000000635I | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 4945 (Georgia) | Primary |
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