DOERUN FAMILY MEDICINE CLINIC NPI 1992147573

NPI Information

NPI: 1992147573
Provider Name: DOERUN FAMILY MEDICINE CLINIC
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
128 WEST BROAD AVE
DOERUN, GA
ZIP 31744
Phone: (229) 891-9131
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DOERUN FAMILY MEDICINE CLINIC is a rural health clinic center in Doerun, GA. DOERUN FAMILY MEDICINE CLINIC NPI is 1992147573. The provider is registered as an organization entity type.

The provider's business location address is:

128 WEST BROAD AVE
DOERUN, GA
ZIP 31744
Phone: (229) 891-9131
Fax: (229) 891-9079

The provider's authorized official is Wendell Larry Sims .
The authorized official title is Cfo and has the following contact phone number (229) 985-3420.

The enumeration date for this NPI number is 7/23/2013 and was last updated on 5/7/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health		GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11-8911	OTHER	GEORGIA	MEDICARE PART A
2	003157266A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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