| Convenient Care Llc | |
|
207 31st Ave Se Moultrie GA 31768-6703 | |
| (229) 890-6054 | |
| (229) 891-4087 |
| Full Name | Convenient Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 207 31st Ave Se, Moultrie, Georgia |
| Authorized Official Name and Position | Gregory L Yarbrough (OWNER) |
| Authorized Official Contact | 2298906054 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Convenient Care Llc Po Box 861 Moultrie GA 31776-0861 Ph: (229) 890-6054 | Convenient Care Llc 207 31st Ave Se Moultrie GA 31768-6703 Ph: (229) 890-6054 |
| NPI Number | 1366734683 |
|---|---|
| Provider Enumeration Date | 05/04/2011 |
| Last Update Date | 12/21/2018 |
| Medicare PECOS PAC ID | 4082886825 |
|---|---|
| Medicare Enrollment ID | O20111020000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366734683 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Clay A Lee |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1215901509 PECOS PAC ID: 7416948328 Enrollment ID: I20040520000096 |
| Provider Name | Shana Leigh Goodno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568779809 PECOS PAC ID: 3173718301 Enrollment ID: I20101112000470 |
| Provider Name | Sydney R Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184089088 PECOS PAC ID: 4486995636 Enrollment ID: I20190416001927 |
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