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702 West Main St Gibson GA 30810-4135 | |
(706) 598-3359 | |
(706) 598-3403 |
Full Name | |
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Speciality | Clinic/Center |
Location | 702 West Main St, Gibson, Georgia |
Authorized Official Name and Position | Carla W Belcher (CEO) |
Authorized Official Contact | 4785527384 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 371 Wrightsville GA 31096-0371 Ph: (478) 864-3448 | 702 West Main St Gibson GA 30810-4135 Ph: (706) 598-3359 |
NPI Number | 1245400969 |
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Provider Enumeration Date | 03/10/2008 |
Last Update Date | 03/02/2016 |
Medicare PECOS PAC ID | 5890783179 |
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Medicare Enrollment ID | O20141117000132 |
Identifier | Type | State | Issuer |
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1245400969 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |