| Supreme Internal Medicine, P.c. | |
|
1207 Merchant Way Suite 201 Statesboro GA 30458-0861 | |
| (912) 243-9080 | |
| (912) 243-9084 |
| Full Name | Supreme Internal Medicine, P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1207 Merchant Way, Statesboro, Georgia |
| Authorized Official Name and Position | Hamilton O Emokpae (PHYSICIAN) |
| Authorized Official Contact | 9122439080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supreme Internal Medicine, P.c. 1207 Merchant Way Suite 201 Statesboro GA 30458 Ph: (912) 243-9080 | Supreme Internal Medicine, P.c. 1207 Merchant Way Suite 201 Statesboro GA 30458-0861 Ph: (912) 243-9080 |
| NPI Number | 1831536341 |
|---|---|
| Provider Enumeration Date | 05/24/2013 |
| Last Update Date | 05/24/2013 |
| Medicare PECOS PAC ID | 4385884626 |
|---|---|
| Medicare Enrollment ID | O20130709000573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831536341 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 68726 (Georgia) | Primary |
| Provider Name | Hamilton O Emokpae |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215013354 PECOS PAC ID: 3971688797 Enrollment ID: I20130709000590 |
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