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16201 Barnesville St Zebulon GA 30295-3380 | |
(770) 567-3323 | |
(770) 567-0332 |
Full Name | |
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Speciality | Clinic/Center |
Location | 16201 Barnesville St, Zebulon, Georgia |
Authorized Official Name and Position | Jon W Wollenzien (CEO) |
Authorized Official Contact | 4049298824 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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643 Main St Palmetto GA 30268-1138 Ph: (404) 929-8824 | 16201 Barnesville St Zebulon GA 30295-3380 Ph: (770) 567-3323 |
NPI Number | 1134344732 |
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Provider Enumeration Date | 04/17/2007 |
Last Update Date | 05/10/2019 |
Medicare PECOS PAC ID | 3476586629 |
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Medicare Enrollment ID | O20050916000963 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134344732 | NPI | - | NPPES |
000228379A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | H800040 (Georgia) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | H800040 (Georgia) | Primary |