| |
118 Robert B Lee Dr Leesburg GA 31763-2600 | |
(229) 759-6508 | |
(229) 759-9950 |
Full Name | |
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Speciality | Clinic/Center |
Location | 118 Robert B Lee Dr, Leesburg, Georgia |
Authorized Official Name and Position | Shelley Spires (CEO) |
Authorized Official Contact | 2298886559 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 542 Leesburg GA 31763-0542 Ph: (229) 759-6508 | 118 Robert B Lee Dr Leesburg GA 31763-2600 Ph: (229) 759-6508 |
NPI Number | 1568497030 |
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Provider Enumeration Date | 07/12/2006 |
Last Update Date | 06/21/2023 |
Medicare PECOS PAC ID | 7911811922 |
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Medicare Enrollment ID | O20070426000090 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568497030 | NPI | - | NPPES |
000674737B | Medicaid | GA | |
000188537A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Concierge Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 152 Station Dr, Leesburg, GA 31763 Phone: 229-814-8426 | |
Medical Associates Of Albany, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 101 Oakland Crossing Dr, Leesburg, GA 31763 Phone: 229-432-1440 Fax: 229-889-8263 |