| Macmed Llc | |
|
2927 Demere Rd Atten: Dr Andrew T Mcrae St Simons Island GA 31522-1620 | |
| (912) 638-1999 | |
| Not Available |
| Full Name | Macmed Llc |
|---|---|
| Speciality | General Practice |
| Location | 2927 Demere Rd, St Simons Island, Georgia |
| Authorized Official Name and Position | Judy S Rivenbark (OWNER) |
| Authorized Official Contact | 8502794917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Macmed Llc 1606 Reynolds St Brunswick GA 31520-6731 Ph: (850) 279-4917 | Macmed Llc 2927 Demere Rd Atten: Dr Andrew T Mcrae St Simons Island GA 31522-1620 Ph: (912) 638-1999 |
| NPI Number | 1417062613 |
|---|---|
| Provider Enumeration Date | 08/20/2006 |
| Last Update Date | 08/29/2012 |
| Medicare PECOS PAC ID | 9032107701 |
|---|---|
| Medicare Enrollment ID | O20040503000555 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417062613 | NPI | - | NPPES |
| 300034700A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | GA051731 (Georgia) | Secondary |
| 208D00000X | General Practice | GA11411 (Georgia) | Primary |
| 208M00000X | Hospitalist | GA11411 (Georgia) | Secondary |
| Provider Name | Thomas W Hobby |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497749733 PECOS PAC ID: 5092763318 Enrollment ID: I20050104000332 |
| Provider Name | Alford T Brady |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467449272 PECOS PAC ID: 8628026960 Enrollment ID: I20050104000504 |
| Provider Name | Rachel G Velez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972545119 PECOS PAC ID: 0042109654 Enrollment ID: I20060404000049 |
| Provider Name | Trent A Schueneman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164484911 PECOS PAC ID: 5597866202 Enrollment ID: I20070725000389 |
| Provider Name | Nancy H Bowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528394848 PECOS PAC ID: 0042353500 Enrollment ID: I20100205000186 |
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