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4402 Second Street Suite B Folkston GA 31537-3124 | |
(912) 496-4839 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 4402 Second Street, Folkston, Georgia |
Authorized Official Name and Position | John Norman Winnie (OWNER) |
Authorized Official Contact | 9124964839 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4402 Second Street Suite B Folkston GA 31537-3124 Ph: (912) 496-4839 | 4402 Second Street Suite B Folkston GA 31537-3124 Ph: (912) 496-4839 |
NPI Number | 1558518357 |
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Provider Enumeration Date | 08/22/2008 |
Last Update Date | 10/19/2010 |
Medicare PECOS PAC ID | 7719053602 |
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Medicare Enrollment ID | O20080828000399 |
Identifier | Type | State | Issuer |
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1558518357 | NPI | - | NPPES |
000469785D | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | 033757 (Georgia) | Primary |
Provider Name | John N Winnie |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1053353938 PECOS PAC ID: 0547336513 Enrollment ID: I20080828000191 |
Peach Care Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3722 Main St, Folkston, GA 31537 Phone: 912-496-3000 | |