D/b/a Grady Primary Care | |
235 1st Ave Ne Cairo GA 39828-2118 | |
(229) 378-2214 | |
(833) 386-7012 |
Full Name | D/b/a Grady Primary Care |
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Speciality | Family Medicine |
Location | 235 1st Ave Ne, Cairo, Georgia |
Authorized Official Name and Position | Kimberly Ann Harbin (OWNER) |
Authorized Official Contact | 2293782214 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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D/b/a Grady Primary Care 235 1st Ave Ne Cairo GA 39828-2118 Ph: (229) 378-2214 | D/b/a Grady Primary Care 235 1st Ave Ne Cairo GA 39828-2118 Ph: (229) 378-2214 |
NPI Number | 1124638614 |
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Provider Enumeration Date | 08/09/2020 |
Last Update Date | 09/02/2021 |
Medicare PECOS PAC ID | 0446679484 |
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Medicare Enrollment ID | O20200924002660 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124638614 | NPI | - | NPPES |
0009544125 | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
Provider Name | Cindy M Caldwell |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407842925 PECOS PAC ID: 4183657919 Enrollment ID: I20050913000765 |
Provider Name | Kimberly A Harbin |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1790731867 PECOS PAC ID: 0941203590 Enrollment ID: I20060821000303 |
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