South Central Primary Care- Ashley Street | |
2301 N Ashley St Valdosta GA 31602-2620 | |
(229) 468-9166 | |
Not Available |
Full Name | South Central Primary Care- Ashley Street |
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Speciality | Clinic/Center |
Location | 2301 N Ashley St, Valdosta, Georgia |
Authorized Official Name and Position | Robert Bonds Tucker (CEO) |
Authorized Official Contact | 2294689166 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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South Central Primary Care- Ashley Street Po Box 749 Ocilla GA 31774-0749 Ph: (229) 468-9166 | South Central Primary Care- Ashley Street 2301 N Ashley St Valdosta GA 31602-2620 Ph: (229) 468-9166 |
NPI Number | 1467223818 |
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Provider Enumeration Date | 01/15/2024 |
Last Update Date | 10/22/2024 |
Medicare PECOS PAC ID | 1951395920 |
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Medicare Enrollment ID | O20240229001353 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467223818 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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