| Providence Family Medicine Clinic, Inc | |
|
1787 Broad Street Providence Family Medicine Clinic, Inc Lumpkin GA 31815 | |
| (703) 593-6154 | |
| Not Available |
| Full Name | Providence Family Medicine Clinic, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1787 Broad Street, Lumpkin, Georgia |
| Authorized Official Name and Position | Sarita Darlene Mobley (CEO) |
| Authorized Official Contact | 7035936154 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Family Medicine Clinic, Inc 1787 Broad St. P.o. Box 685 Lumpkin GA 31815 Ph: (703) 593-6154 | Providence Family Medicine Clinic, Inc 1787 Broad Street Providence Family Medicine Clinic, Inc Lumpkin GA 31815 Ph: (703) 593-6154 |
| NPI Number | 1346590148 |
|---|---|
| Provider Enumeration Date | 09/19/2012 |
| Last Update Date | 09/19/2012 |
| Medicare PECOS PAC ID | 7719138577 |
|---|---|
| Medicare Enrollment ID | O20121105000262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346590148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 046872 (Georgia) | Primary |
| Provider Name | Sarita Darlene Mobley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245300896 PECOS PAC ID: 8628229481 Enrollment ID: I20121107000750 |
| Provider Name | Linda F Eason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568544427 PECOS PAC ID: 3678878311 Enrollment ID: I20160218000289 |
| Provider Name | April L Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003388828 PECOS PAC ID: 7719318971 Enrollment ID: I20200504001997 |
Lumpkin Family Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 153 W Broad St, Lumpkin, GA 31815 Phone: 229-838-0885 |