| Clopton Primary Care | |
|
195 Fairview Rd Ellenwood GA 30294-2722 | |
| (770) 507-0112 | |
| (770) 507-9450 |
| Full Name | Clopton Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 195 Fairview Rd, Ellenwood, Georgia |
| Authorized Official Name and Position | Lisa B Green-clopton (CFO/ BUSINESS MANAGER) |
| Authorized Official Contact | 7705070112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clopton Primary Care Po Box 90237 East Point GA 30364-0237 Ph: (770) 507-0112 | Clopton Primary Care 195 Fairview Rd Ellenwood GA 30294-2722 Ph: (770) 507-0112 |
| NPI Number | 1699879965 |
|---|---|
| Provider Enumeration Date | 09/08/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4981691516 |
|---|---|
| Medicare Enrollment ID | O20040427000719 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699879965 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 043019 (Georgia) | Primary |
| Provider Name | Charles V Clopton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770514440 PECOS PAC ID: 7911989231 Enrollment ID: I20040602000165 |
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