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15 S Railroad St Lenox GA 31637-7424 | |
(229) 546-4206 | |
(229) 546-4612 |
Full Name | |
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Speciality | Clinic/Center |
Location | 15 S Railroad St, Lenox, Georgia |
Authorized Official Name and Position | Robert Bonds Tucker (CEO) |
Authorized Official Contact | 2294689166 |
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 749 Ocilla GA 31774-0749 Ph: (229) 468-9166 | 15 S Railroad St Lenox GA 31637-7424 Ph: (229) 546-4206 |
NPI Number | 1548768625 |
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Provider Enumeration Date | 01/24/2018 |
Last Update Date | 11/26/2024 |
Medicare PECOS PAC ID | 1951395920 |
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Medicare Enrollment ID | O20180501000899 |
Identifier | Type | State | Issuer |
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1548768625 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |