| Healing Roots Family Practice Llc | |
|
111 N Pine St Trenton GA 30752-2503 | |
| (706) 657-4985 | |
| Not Available |
| Full Name | Healing Roots Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 111 N Pine St, Trenton, Georgia |
| Authorized Official Name and Position | Crystal Hancock (OWNER) |
| Authorized Official Contact | 7066574985 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Roots Family Practice Llc 111 N Pine St Trenton GA 30752-2503 Ph: (706) 657-4985 | Healing Roots Family Practice Llc 111 N Pine St Trenton GA 30752-2503 Ph: (706) 657-4985 |
| NPI Number | 1831858802 |
|---|---|
| Provider Enumeration Date | 12/16/2021 |
| Last Update Date | 12/16/2021 |
| Medicare PECOS PAC ID | 9133516115 |
|---|---|
| Medicare Enrollment ID | O20220421000189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831858802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Crystal L Hancock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881019305 PECOS PAC ID: 1153544457 Enrollment ID: I20140513001669 |
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