| Ms Susan Brickle, MD | |
|
120 E Carter Ave, Blackshear, GA 31516-1561 | |
| (912) 449-4426 | |
| (912) 449-1059 |
| Full Name | Ms Susan Brickle |
|---|---|
| Gender | Female |
| Speciality | Family Medicine |
| Location | 120 E Carter Ave, Blackshear, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407876188 | NPI | - | NPPES |
| 00734467E | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 031883 (Georgia) | Primary |
| Entity Name | Acs Primary Care Physicians - Southeast Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1861430555 PECOS PAC ID: 5193620714 Enrollment ID: O20040901000766 |
| Entity Name | St Vincent's Ambulatory Care Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1417987124 PECOS PAC ID: 2860411188 Enrollment ID: O20051129000302 |
| Entity Name | Hospital Physician Services - Southeast Professional Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760410385 PECOS PAC ID: 5597774554 Enrollment ID: O20060419000545 |
| Entity Name | Privia Medical Group Of Georgia Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013313857 PECOS PAC ID: 4284951542 Enrollment ID: O20150325000983 |
| Mailing Address | Practice Location Address |
|---|---|
| Ms Susan Brickle, MD 120 E Carter Ave, Blackshear, GA 31516-1561 Ph: (912) 449-4426 | Ms Susan Brickle, MD 120 E Carter Ave, Blackshear, GA 31516-1561 Ph: (912) 449-4426 |
Mr. Thomas W Davis, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 147 Longleaf Dr, Blackshear, GA 31516 Phone: 912-449-6243 | |
Jeffrey P. Davenport, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 120 Carter Ave, Blackshear Family Practice, Blackshear, GA 31516 Phone: 912-449-4426 | |
Mr. Gordon Brent Waters, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 120 E Carter Ave, Blackshear, GA 31516 Phone: 912-449-4426 Fax: 912-449-1059 | |
Mr. Donald B. Waters, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 120 E Carter Ave, Blackshear, GA 31516 Phone: 912-449-4426 Fax: 912-449-1517 |