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654 S Main St Baxley GA 31513-0124 | |
| (912) 367-4122 | |
| (912) 367-4136 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 654 S Main St, Baxley, Georgia |
| Authorized Official Name and Position | Andrea Pierce (CEO) |
| Authorized Official Contact | 9123679841 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2070 Baxley GA 31515-2070 Ph: (912) 367-4122 | 654 S Main St Baxley GA 31513-0124 Ph: (912) 367-4122 |
| NPI Number | 1255570321 |
|---|---|
| Provider Enumeration Date | 02/13/2009 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 8426957325 |
|---|---|
| Medicare Enrollment ID | O20090602000538 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255570321 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 001-502 (Georgia) | Primary |
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