| Mcrae Clinic | |
|
410 Lakeside Drive Mcrae GA 31055 | |
| (478) 272-1190 | |
| (478) 274-7628 |
| Full Name | Mcrae Clinic |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 410 Lakeside Drive, Mcrae, Georgia |
| Authorized Official Name and Position | Robert Keith Moran (CFO) |
| Authorized Official Contact | 4782721190 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mcrae Clinic 2121a Bellevue Rd Dublin GA 31021-2998 Ph: (478) 272-1190 | Mcrae Clinic 410 Lakeside Drive Mcrae GA 31055 Ph: (478) 272-1190 |
| NPI Number | 1912030008 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 07/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912030008 | NPI | - | NPPES |
| 000606284L | Medicaid | GA | |
| 300030912A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |