Clopton Primary Care | |
195 Fairview Rd Ellenwood GA 30294-2722 | |
(770) 507-0112 | |
(770) 507-9450 |
Full Name | Clopton Primary Care |
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Speciality | Family Medicine |
Location | 195 Fairview Rd, Ellenwood, Georgia |
Authorized Official Name and Position | Lisa B Green-clopton (CFO/ BUSINESS MANAGER) |
Authorized Official Contact | 7705070112 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Clopton Primary Care Po Box 90237 East Point GA 30364-0237 Ph: (770) 507-0112 | Clopton Primary Care 195 Fairview Rd Ellenwood GA 30294-2722 Ph: (770) 507-0112 |
NPI Number | 1699879965 |
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Provider Enumeration Date | 09/08/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 4981691516 |
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Medicare Enrollment ID | O20040427000719 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699879965 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 043019 (Georgia) | Primary |
Provider Name | Charles V Clopton |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1770514440 PECOS PAC ID: 7911989231 Enrollment ID: I20040602000165 |
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