| Nw Ga Specialty Clinic | |
|
16 East 12th Street Suite 202 Rome GA 30161-4720 | |
| (706) 295-6701 | |
| (706) 295-6697 |
| Full Name | Nw Ga Specialty Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 16 East 12th Street, Rome, Georgia |
| Authorized Official Name and Position | Christopher Wade Sellers (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7062956704 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nw Ga Specialty Clinic 16 East 12th Street Suite 202 Rome GA 30161-4720 Ph: (706) 295-6701 | Nw Ga Specialty Clinic 16 East 12th Street Suite 202 Rome GA 30161-4720 Ph: (706) 295-6701 |
| NPI Number | 1851432173 |
|---|---|
| Provider Enumeration Date | 02/09/2007 |
| Last Update Date | 03/30/2011 |
| Medicare PECOS PAC ID | 6709872245 |
|---|---|
| Medicare Enrollment ID | O20040421001224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851432173 | NPI | - | NPPES |
| 000428205D | Medicaid | GA | |
| 000505733D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | 025271 (Georgia) | Primary |
| Provider Name | Mark P Elam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669559035 PECOS PAC ID: 5799764429 Enrollment ID: I20040716000280 |
| Provider Name | Katharine M Ammons |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962562207 PECOS PAC ID: 1052356037 Enrollment ID: I20050621000331 |
| Provider Name | Myra M Belcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457425795 PECOS PAC ID: 4880847821 Enrollment ID: I20121227000051 |
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