Peach Care Llc | |
3722 Main St Folkston GA 31537-7540 | |
(912) 496-3000 | |
Not Available |
Full Name | Peach Care Llc |
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Speciality | Internal Medicine |
Location | 3722 Main St, Folkston, Georgia |
Authorized Official Name and Position | Maged E Abdelmalik (CEO) |
Authorized Official Contact | 9124963000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Peach Care Llc 3722 Main St Folkston GA 31537-7540 Ph: (912) 496-3000 | Peach Care Llc 3722 Main St Folkston GA 31537-7540 Ph: (912) 496-3000 |
NPI Number | 1730598491 |
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Provider Enumeration Date | 08/07/2014 |
Last Update Date | 08/07/2014 |
Medicare PECOS PAC ID | 0648592634 |
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Medicare Enrollment ID | O20141202000936 |
Identifier | Type | State | Issuer |
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1730598491 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | 55077 (Georgia) | Primary |
Provider Name | Maged Abdelmalik |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1770558470 PECOS PAC ID: 5496724858 Enrollment ID: I20041001000322 |
Provider Name | Betsy E Tanner |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295387751 PECOS PAC ID: 7113128141 Enrollment ID: I20191211003242 |