Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 72 S Broad St, Ellaville, Georgia |
Authorized Official Name and Position | Troy David Hammett (VP FINANCE CFO) |
Authorized Official Contact | 2299311280 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 65 Americus GA 31719 Ph: (229) 924-6011 | 72 S Broad St Ellaville GA 31806 Ph: (229) 937-5321 |
NPI Number | 1477647824 |
---|---|
Provider Enumeration Date | 10/02/2006 |
Last Update Date | 02/26/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1477647824 | NPI | - | NPPES |
00000019F | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Georgia) | Primary |
Southwest Ga Primary Care, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 93 S Broad St, Ellaville, GA 31806 Phone: 229-410-9965 Fax: 229-937-9007 |