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72 S. Broad St. Ellaville GA 31806 | |
(229) 937-5321 | |
(229) 937-2232 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 72 S. Broad St., Ellaville, Georgia |
Authorized Official Name and Position | Maryanne Shepherd (DIRECTOR) |
Authorized Official Contact | 2299375321 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 65 Ellaville GA 31806-0065 Ph: (229) 937-5321 | 72 S. Broad St. Ellaville GA 31806 Ph: (229) 937-5321 |
NPI Number | 1487719076 |
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Provider Enumeration Date | 12/26/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1487719076 | NPI | - | NPPES |
00000019F | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | 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 |