Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 6459 Us Hwy 301 S, Claxton, Georgia |
Authorized Official Name and Position | Jill R Sorrells (CFO) |
Authorized Official Contact | 4782376262 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
215 N Coleman St Swainsboro GA 30401-3530 Ph: (478) 299-6992 | 6459 Us Hwy 301 S Claxton GA 30417 Ph: (478) 299-6992 |
NPI Number | 1235621418 |
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Provider Enumeration Date | 06/04/2018 |
Last Update Date | 06/04/2018 |
Medicare PECOS PAC ID | 0547228686 |
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Medicare Enrollment ID | O20180906002886 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235621418 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |