Douglas Medical Specialist | |
134 E Fleetwood Ave Willacoochee GA 31650 | |
(912) 384-3338 | |
(912) 383-6365 |
Full Name | Douglas Medical Specialist |
---|---|
Speciality | Internal Medicine |
Location | 134 E Fleetwood Ave, Willacoochee, Georgia |
Authorized Official Name and Position | Marshall G Tanner (DIRECTOR) |
Authorized Official Contact | 9123843338 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Douglas Medical Specialist 134 E Fleetwood Ave Willacoochee GA 31650 Ph: (912) 384-3338 | Douglas Medical Specialist 134 E Fleetwood Ave Willacoochee GA 31650 Ph: (912) 384-3338 |
NPI Number | 1114114055 |
---|---|
Provider Enumeration Date | 09/25/2007 |
Last Update Date | 10/30/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114114055 | NPI | - | NPPES |
1326031865 | Other | GA | NPI |
1891815924 | Other | GA | NPI |
1225021678 | Other | GA | NPI |
1750374294 | Other | GA | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 056658 (Georgia) | Primary |
Ich Physician Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 134 Fleetwood Ave E, Willacoochee, GA 31650 Phone: 912-534-5142 Fax: 912-534-6120 |