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41 East Oglethorpe Street Ellaville GA 31806 | |
(229) 937-9003 | |
(229) 937-9007 |
Full Name | |
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Speciality | Clinic/Center |
Location | 41 East Oglethorpe Street, Ellaville, Georgia |
Authorized Official Name and Position | Linda Young (SECRETARY) |
Authorized Official Contact | 2292738881 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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41 East Oglethorpe Street Ellaville GA 31806 Ph: (229) 937-9003 | 41 East Oglethorpe Street Ellaville GA 31806 Ph: (229) 937-9003 |
NPI Number | 1487036075 |
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Provider Enumeration Date | 06/19/2015 |
Last Update Date | 01/06/2020 |
Medicare PECOS PAC ID | 7810980794 |
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Medicare Enrollment ID | O20151002002528 |
Identifier | Type | State | Issuer |
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1487036075 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Southwest Ga Primary Care, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 93 S Broad St, Ellaville, GA 31806 Phone: 229-410-9965 Fax: 229-937-9007 |