| Houston Family Medicine | |
|
106 Moran Drive Bonaire GA 31005 | |
| (478) 988-1282 | |
| (478) 988-3120 |
| Full Name | Houston Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 106 Moran Drive, Bonaire, Georgia |
| Authorized Official Name and Position | Samuel E Palmer (OWNER) |
| Authorized Official Contact | 4789881282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Houston Family Medicine 106 Moran Drive Bonaire GA 31005-2948 Ph: (478) 988-1282 | Houston Family Medicine 106 Moran Drive Bonaire GA 31005 Ph: (478) 988-1282 |
| NPI Number | 1376555300 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 05/15/2009 |
| Medicare PECOS PAC ID | 3870563034 |
|---|---|
| Medicare Enrollment ID | O20040727000828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376555300 | NPI | - | NPPES |
| 000374382K | Medicaid | GA | |
| 092100603D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 029061 (Georgia) | Primary |
| Provider Name | Samuel E Palmer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083663348 PECOS PAC ID: 0244219392 Enrollment ID: I20040714000567 |
| Provider Name | Melanie D Shorter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518915909 PECOS PAC ID: 7618947623 Enrollment ID: I20040728000327 |
| Provider Name | Dona M Tuten |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386674612 PECOS PAC ID: 2769495696 Enrollment ID: I20060719000234 |
| Provider Name | Jacquita Nicole Baker Baldwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861034415 PECOS PAC ID: 5092140483 Enrollment ID: I20200113001110 |
| Provider Name | Roneseya Bentley Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225575277 PECOS PAC ID: 5092115758 Enrollment ID: I20210617000180 |
| Provider Name | Oshin Kimberlee Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407553365 PECOS PAC ID: 9436524329 Enrollment ID: I20230406000837 |
Robins Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 103 Haven Crst, Bonaire, GA 31005 Phone: 478-287-6040 Fax: 478-225-9721 |