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11949 Us Highway 41 Pinehurst GA 31070-7467 | |
(229) 947-6194 | |
(229) 645-3940 |
Full Name | |
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Speciality | Clinic/Center |
Location | 11949 Us Highway 41, Pinehurst, 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 | 11949 Us Highway 41 Pinehurst GA 31070-7467 Ph: (229) 947-6194 |
NPI Number | 1427413137 |
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Provider Enumeration Date | 12/22/2015 |
Last Update Date | 01/26/2016 |
Medicare PECOS PAC ID | 7911811922 |
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Medicare Enrollment ID | O20160224001199 |
Identifier | Type | State | Issuer |
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1427413137 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |