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103 Re Jennings Ave Se Arlington GA 39813-8725 | |
(229) 725-4251 | |
(229) 725-2212 |
Full Name | |
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Speciality | Clinic/Center |
Location | 103 Re Jennings Ave Se, Arlington, Georgia |
Authorized Official Name and Position | Robin A Rau (CEO) |
Authorized Official Contact | 2297585954 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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209 N Cuthbert St Colquitt GA 39837-3518 Ph: (229) 758-4200 | 103 Re Jennings Ave Se Arlington GA 39813-8725 Ph: (229) 725-4251 |
NPI Number | 1235227752 |
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Provider Enumeration Date | 10/10/2006 |
Last Update Date | 11/02/2021 |
Medicare PECOS PAC ID | 0244224947 |
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Medicare Enrollment ID | O20130617000633 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235227752 | NPI | - | NPPES |
003140349A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |