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1114 Ga Highway 96 Ste D3-d5 Kathleen GA 31047-2111 | |
(478) 910-1090 | |
(478) 910-1091 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1114 Ga Highway 96 Ste D3-d5, Kathleen, Georgia |
Authorized Official Name and Position | Linda Young (EXECUTIVE SECRETARY) |
Authorized Official Contact | 2292738881 |
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 5610 Cordele GA 31010-5610 Ph: (229) 273-8881 | 1114 Ga Highway 96 Ste D3-d5 Kathleen GA 31047-2111 Ph: (478) 910-1090 |
NPI Number | 1447833926 |
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Provider Enumeration Date | 05/03/2021 |
Last Update Date | 05/04/2022 |
Medicare PECOS PAC ID | 7810980794 |
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Medicare Enrollment ID | O20220421000322 |
Identifier | Type | State | Issuer |
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1447833926 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Quincy Jordan Md Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2350 South Houston Lake Rd, #902, Kathleen, GA 31047 Phone: 877-610-2791 |