| Dr William David Breedlove, Llc | |
|
162 Hospital Rd Ste A Blairsville GA 30512 | |
| (706) 745-3333 | |
| (706) 745-7188 |
| Full Name | Dr William David Breedlove, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 162 Hospital Rd, Blairsville, Georgia |
| Authorized Official Name and Position | William David Breedlove (CEO) |
| Authorized Official Contact | 7067453333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr William David Breedlove, Llc P.o. Box 1907 Blairsville GA 30514 Ph: (706) 745-3333 | Dr William David Breedlove, Llc 162 Hospital Rd Ste A Blairsville GA 30512 Ph: (706) 745-3333 |
| NPI Number | 1184150245 |
|---|---|
| Provider Enumeration Date | 05/11/2017 |
| Last Update Date | 12/06/2023 |
| Medicare PECOS PAC ID | 3678828951 |
|---|---|
| Medicare Enrollment ID | O20180611002111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184150245 | NPI | - | NPPES |
| 00325927B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 026465 (Georgia) | Primary |
| Provider Name | William Breedlove |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801999297 PECOS PAC ID: 7517042351 Enrollment ID: I20100512000877 |
| Provider Name | Kelly Fendley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861832628 PECOS PAC ID: 4789949165 Enrollment ID: I20180606001030 |
| Provider Name | Sheila L Whitener |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1023456183 PECOS PAC ID: 6103172556 Enrollment ID: I20180627003068 |
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