Waynesboro Clinic, Llc | |
206 Clifton Tpke Waynesboro TN 38485-2301 | |
(931) 722-3677 | |
(931) 722-4677 |
Full Name | Waynesboro Clinic, Llc |
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Speciality | Family Medicine |
Location | 206 Clifton Tpke, Waynesboro, Tennessee |
Authorized Official Name and Position | Donald Howard Polk (MEMBER/PHYSICIAN) |
Authorized Official Contact | 9317223677 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Waynesboro Clinic, Llc Po Box 778 Waynesboro TN 38485-0778 Ph: () - | Waynesboro Clinic, Llc 206 Clifton Tpke Waynesboro TN 38485-2301 Ph: (931) 722-3677 |
NPI Number | 1407207814 |
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Provider Enumeration Date | 06/27/2016 |
Last Update Date | 06/27/2016 |
Medicare PECOS PAC ID | 3577859248 |
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Medicare Enrollment ID | O20160906001848 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407207814 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | DO127 (Tennessee) | Primary |
Provider Name | Donald H Polk |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1497747778 PECOS PAC ID: 0143212977 Enrollment ID: I20040401000573 |
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