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2383 Third St Folkston GA 31537-8917 | |
(912) 496-2697 | |
(912) 496-1139 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 2383 Third St, Folkston, Georgia |
Authorized Official Name and Position | Fatima Mccasland (CLINIC DIRECTOR) |
Authorized Official Contact | 9124962697 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2383 Third St Folkston GA 31537-8917 Ph: (912) 496-2697 | 2383 Third St Folkston GA 31537-8917 Ph: (912) 496-2697 |
NPI Number | 1760548002 |
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Provider Enumeration Date | 12/29/2006 |
Last Update Date | 07/26/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760548002 | NPI | - | NPPES |
814096430A | Medicaid | GA | |
HOSP45 | Other | GA | MEDICARE PART B PTAN |
164482236A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Peach Care Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3722 Main St, Folkston, GA 31537 Phone: 912-496-3000 | |