| Wide Range Of Resources, Inc | |
|
1776 N Jefferson St Ne Suite B Milledgeville GA 31061-2229 | |
| (478) 451-3112 | |
| (478) 451-0626 |
| Full Name | Wide Range Of Resources, Inc |
|---|---|
| Speciality | Clinic/center |
| Location | 1776 N Jefferson St Ne, Milledgeville, Georgia |
| Authorized Official Name and Position | Frezalia L. Oliver (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4784513112 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wide Range Of Resources, Inc 1776 N Jefferson St Ne Suite B Milledgeville GA 31061-2229 Ph: (478) 451-3112 | Wide Range Of Resources, Inc 1776 N Jefferson St Ne Suite B Milledgeville GA 31061-2229 Ph: (478) 451-3112 |
| NPI Number | 1043459878 |
|---|---|
| Provider Enumeration Date | 02/18/2009 |
| Last Update Date | 02/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043459878 | NPI | - | NPPES |
| 538773445A | Medicaid | GA | |
| GRP7368 | Other | GA | MEDICARE GROUP PIN |
| 139858482A | Medicaid | GA | |
| 139858482B | Medicaid | GA | |
| 139858482C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | CSW00658 (Georgia) | Primary |
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