| Community Georgia | |
|
500 Lanier Ave W Fayetteville GA 30214-7636 | |
| (520) 524-6084 | |
| Not Available |
| Full Name | Community Georgia |
|---|---|
| Speciality | Clinic/Center |
| Location | 500 Lanier Ave W, Fayetteville, Georgia |
| Authorized Official Name and Position | Sheonkei M Givner (OWNER) |
| Authorized Official Contact | 6145004150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Georgia 500 Lanier Ave W Fayetteville GA 30214-7636 Ph: (520) 524-6084 | Community Georgia 500 Lanier Ave W Fayetteville GA 30214-7636 Ph: (520) 524-6084 |
| NPI Number | 1578318689 |
|---|---|
| Provider Enumeration Date | 04/22/2024 |
| Last Update Date | 04/22/2024 |
| Certification Date | 04/22/2024 |
| Medicare PECOS PAC ID | 5395287452 |
|---|---|
| Medicare Enrollment ID | O20240613001723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578318689 | NPI | - | NPPES |
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