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704 Breedlove Dr Ste B Monroe GA 30655-2054 | |
(770) 266-0935 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 704 Breedlove Dr Ste B, Monroe, Georgia |
Authorized Official Name and Position | David Ward (CEO) |
Authorized Official Contact | 7067883234 |
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 459 Colbert GA 30628-0459 Ph: (706) 788-3234 | 704 Breedlove Dr Ste B Monroe GA 30655-2054 Ph: (770) 266-0935 |
NPI Number | 1669833364 |
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Provider Enumeration Date | 03/09/2016 |
Last Update Date | 08/05/2020 |
Medicare PECOS PAC ID | 3274442850 |
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Medicare Enrollment ID | O20160516000686 |
Identifier | Type | State | Issuer |
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1669833364 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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