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254 Wright Avenue Roberta GA 31078 | |
(229) 384-5576 | |
(229) 384-5527 |
Full Name | |
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Speciality | Clinic/Center |
Location | 254 Wright Avenue, Roberta, Georgia |
Authorized Official Name and Position | Linda Young (EXECUTIVE 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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Po Box 5610 Cordele GA 31010-5610 Ph: (229) 273-8881 | 254 Wright Avenue Roberta GA 31078 Ph: (229) 384-5576 |
NPI Number | 1649810714 |
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Provider Enumeration Date | 01/07/2020 |
Last Update Date | 05/09/2022 |
Medicare PECOS PAC ID | 7810980794 |
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Medicare Enrollment ID | O20200215000212 |
Identifier | Type | State | Issuer |
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1649810714 | NPI | - | NPPES |
========= | Other | GA | TAX IDENTIFICATION NUMBER |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |