Organization · Type 2 NPI
Southwest Ga Primary Care, LLC
Primary Care Clinic/Center · Ellaville, GA
NPI number
1629400312
Active
Practice location
93 S Broad St
Ellaville, GA 31806-0989
Fax (229) 937-9007
Mailing address
PO Box 989
Ellaville, GA 31806-0989
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Clinic/Center Primary | 261QP2300X | 33367 (GA) |
Primary Care Clinic/Center: Definition to come...
About NPI 1629400312
Southwest Ga Primary Care, LLC's National Provider Identifier is 1629400312, issued on Aug 5, 2013. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Ellaville, GA. The record was last updated on Jun 5, 2014.