| Tennille Community Health Center | |
|
116 Smith St Tennille GA 31089-1465 | |
| (478) 552-7384 | |
| (478) 552-1198 |
| Full Name | Tennille Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 116 Smith St, Tennille, Georgia |
| Authorized Official Name and Position | Lynn W Price (INSURANCE SUPERVISOR) |
| Authorized Official Contact | 4788643448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tennille Community Health Center 2251 W Elm St Wrightsville GA 31096-2017 Ph: (478) 864-3448 | Tennille Community Health Center 116 Smith St Tennille GA 31089-1465 Ph: (478) 552-7384 |
| NPI Number | 1104876390 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 11/22/2011 |
| Medicare PECOS PAC ID | 5890783179 |
|---|---|
| Medicare Enrollment ID | O20100617000272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104876390 | NPI | - | NPPES |
| 000521023G | Medicaid | GA | |
| 300029381A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |