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23 Old School Road Georgetown GA 39854-4627 | |
(229) 334-9353 | |
(229) 334-6983 |
Full Name | |
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Speciality | Clinic/Center |
Location | 23 Old School Road, Georgetown, 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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P.o. Box 5610 Cordele GA 31010-1514 Ph: (229) 334-9353 | 23 Old School Road Georgetown GA 39854-4627 Ph: (229) 334-9353 |
NPI Number | 1962410613 |
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Provider Enumeration Date | 08/04/2006 |
Last Update Date | 01/06/2020 |
Medicare PECOS PAC ID | 7810980794 |
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Medicare Enrollment ID | O20060925000457 |
Identifier | Type | State | Issuer |
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1962410613 | NPI | - | NPPES |
000219678E | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |