| Ancor South Comp | |
|
89 Highway 48 Summerville GA 30747-1506 | |
| (706) 638-5580 | |
| (706) 638-5445 |
| Full Name | Ancor South Comp |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 89 Highway 48, Summerville, Georgia |
| Authorized Official Name and Position | Alicia Michelle Howard (CREDENTIALING) |
| Authorized Official Contact | 7066701080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ancor South Comp Po Box 1027 La Fayette GA 30728-1027 Ph: (706) 638-5580 | Ancor South Comp 89 Highway 48 Summerville GA 30747-1506 Ph: (706) 638-5580 |
| NPI Number | 1114257862 |
|---|---|
| Provider Enumeration Date | 12/31/2009 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114257862 | NPI | - | NPPES |
| 000604513BV | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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