| Your Personal Physician | |
|
701 E 2nd Ave Sw Suite C Rome GA 30161-6148 | |
| (706) 266-9090 | |
| (706) 204-8797 |
| Full Name | Your Personal Physician |
|---|---|
| Speciality | Family Medicine |
| Location | 701 E 2nd Ave Sw, Rome, Georgia |
| Authorized Official Name and Position | Michael S Jackson (PRESIDENT) |
| Authorized Official Contact | 7062669090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Personal Physician Po Box 40 Silver Creek GA 30173-0040 Ph: (706) 266-9090 | Your Personal Physician 701 E 2nd Ave Sw Suite C Rome GA 30161-6148 Ph: (706) 266-9090 |
| NPI Number | 1164745782 |
|---|---|
| Provider Enumeration Date | 03/10/2010 |
| Last Update Date | 01/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164745782 | NPI | - | NPPES |
| 08BBRKT | Other | GA | MEDICARE PTAN |
| 1306830062 | Other | MEDICARE INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 055376 (Georgia) | Primary |
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