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3689 Wilma Edwards Rd Ellabell GA 31308-5315 | |
(912) 653-4357 | |
(912) 653-4320 |
Full Name | |
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Speciality | Family Medicine |
Location | 3689 Wilma Edwards Rd, Ellabell, Georgia |
Authorized Official Name and Position | Michael Andrew Register (OWNER) |
Authorized Official Contact | 9126534357 |
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 1047 Ellabell GA 31308-1047 Ph: (912) 653-4357 | 3689 Wilma Edwards Rd Ellabell GA 31308-5315 Ph: (912) 653-4357 |
NPI Number | 1871622548 |
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Provider Enumeration Date | 03/05/2007 |
Last Update Date | 01/13/2021 |
Medicare PECOS PAC ID | 0840271250 |
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Medicare Enrollment ID | O20040601000086 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871622548 | NPI | - | NPPES |
529605996A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 026924 (Georgia) | Primary |
Provider Name | Michael A Register |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1174675748 PECOS PAC ID: 5193706505 Enrollment ID: I20040601000108 |