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7306 Ga Highway 21 Ste 105 Port Wentworth GA 31407-9275 | |
(912) 966-2575 | |
(912) 966-0906 |
Full Name | |
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Speciality | Clinic/center |
Location | 7306 Ga Highway 21, Port Wentworth, Georgia |
Authorized Official Name and Position | Francine Baker-witt (INTERIM CEO) |
Authorized Official Contact | 9127540142 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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459 Highway 119 South Attn.: Alia Allen/medical Staff Office Springfield GA 31329 Ph: (912) 754-0175 | 7306 Ga Highway 21 Ste 105 Port Wentworth GA 31407-9275 Ph: (912) 966-2575 |
NPI Number | 1891925608 |
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Provider Enumeration Date | 07/15/2009 |
Last Update Date | 11/29/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891925608 | NPI | - | NPPES |
HOSP150 | Other | GA | MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (Georgia) | Primary |