Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 521 Lax Hwy, Ocilla, Georgia |
Authorized Official Name and Position | Robert Bonds Tucker (CEO) |
Authorized Official Contact | 2294689166 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 749 Ocilla GA 31774-0749 Ph: (229) 468-9166 | 521 Lax Hwy Ocilla GA 31774-2225 Ph: (229) 468-9166 |
NPI Number | 1811625486 |
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Provider Enumeration Date | 08/11/2022 |
Last Update Date | 11/26/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811625486 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Irwin Specialty Centers Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 710 N Irwin Ave, Ocilla, GA 31774 Phone: 229-468-3800 | |