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636 Second Avenue, Sw Rochelle GA 31079 | |
(229) 365-2570 | |
(229) 365-2571 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 636 Second Avenue, Sw, Rochelle, Georgia |
Authorized Official Name and Position | James Miller (DIRECTOR PHYSICIAN PRACTICES) |
Authorized Official Contact | 2292714676 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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636 Second Avenue, Sw Rochelle GA 31079 Ph: (229) 365-2570 | 636 Second Avenue, Sw Rochelle GA 31079 Ph: (229) 365-2570 |
NPI Number | 1902013048 |
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Provider Enumeration Date | 05/17/2007 |
Last Update Date | 05/27/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902013048 | NPI | - | NPPES |
00000514H | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Georgia) | Primary |