Malozera Primary Care, Llc | |
2809 Pine St Unadilla GA 31091-7701 | |
(478) 355-3000 | |
(478) 355-3001 |
Full Name | Malozera Primary Care, Llc |
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Speciality | Family Medicine |
Location | 2809 Pine St, Unadilla, Georgia |
Authorized Official Name and Position | Alexander C Ibezi-enendu (OWNER) |
Authorized Official Contact | 4047029466 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Malozera Primary Care, Llc P O Box 8203 Warner Robins GA 31095-8203 Ph: (478) 783-3610 | Malozera Primary Care, Llc 2809 Pine St Unadilla GA 31091-7701 Ph: (478) 355-3000 |
NPI Number | 1912544784 |
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Provider Enumeration Date | 11/29/2019 |
Last Update Date | 11/18/2023 |
Medicare PECOS PAC ID | 4789010430 |
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Medicare Enrollment ID | O20200129000718 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912544784 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Alexander C Ibezi-enendu |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1154615979 PECOS PAC ID: 3274832894 Enrollment ID: I20160706002548 |
Healthcare Of Unadilla Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2900 Pine Street, Unadilla, GA 31091 Phone: 478-627-3341 | |
Taylor Physicians Practice # 24 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2809 Pine St Ste 101, Unadilla, GA 31091 Phone: 478-927-3213 Fax: 478-627-3669 |