| Quail Ridge Family Practice, Llc | |
|
1 Doctors Park Cairo GA 39828 | |
| (229) 378-8110 | |
| (229) 378-8109 |
| Full Name | Quail Ridge Family Practice, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1 Doctors Park, Cairo, Georgia |
| Authorized Official Name and Position | Mark C Hudson (OWNER) |
| Authorized Official Contact | 2293788110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Quail Ridge Family Practice, Llc 1 Doctors Park Cairo GA 39828-3072 Ph: (229) 378-8110 | Quail Ridge Family Practice, Llc 1 Doctors Park Cairo GA 39828 Ph: (229) 378-8110 |
| NPI Number | 1457314999 |
|---|---|
| Provider Enumeration Date | 04/07/2006 |
| Last Update Date | 07/05/2018 |
| Medicare PECOS PAC ID | 8628043957 |
|---|---|
| Medicare Enrollment ID | O20040831000652 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457314999 | NPI | - | NPPES |
| 986982597A | Medicaid | GA | |
| 345982719A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Georgia) | Primary |
| Provider Name | Mark C Hudson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437112497 PECOS PAC ID: 1052386281 Enrollment ID: I20040831000699 |
| Provider Name | Brianna C Millsaps |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790281723 PECOS PAC ID: 6002169752 Enrollment ID: I20220419000044 |
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