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505 Forrester Drive Se Dawson GA 39842 | |
(229) 995-2990 | |
(229) 995-2993 |
Full Name | |
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Speciality | Clinic/Center |
Location | 505 Forrester Drive Se, Dawson, Georgia |
Authorized Official Name and Position | Shelley Spires (CEO) |
Authorized Official Contact | 2298886559 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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204 N Westover Blvd Albany GA 31707-2983 Ph: (229) 888-6559 | 505 Forrester Drive Se Dawson GA 39842 Ph: (229) 995-2990 |
NPI Number | 1730114208 |
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Provider Enumeration Date | 07/12/2006 |
Last Update Date | 07/03/2023 |
Medicare PECOS PAC ID | 7911811922 |
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Medicare Enrollment ID | O20050907000798 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730114208 | NPI | - | NPPES |
000797585A | Medicaid | GA | |
000797585B | Medicaid | GA | |
CI1481 | Other | GA | RR MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |