| Douglas Medical Specialist | |
|
134 E Fleetwood Ave Willacoochee GA 31650 | |
| (912) 384-3338 | |
| (912) 383-6365 |
| Full Name | Douglas Medical Specialist |
|---|---|
| Speciality | Internal Medicine |
| Location | 134 E Fleetwood Ave, Willacoochee, Georgia |
| Authorized Official Name and Position | Marshall G Tanner (DIRECTOR) |
| Authorized Official Contact | 9123843338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas Medical Specialist 134 E Fleetwood Ave Willacoochee GA 31650 Ph: (912) 384-3338 | Douglas Medical Specialist 134 E Fleetwood Ave Willacoochee GA 31650 Ph: (912) 384-3338 |
| NPI Number | 1114114055 |
|---|---|
| Provider Enumeration Date | 09/25/2007 |
| Last Update Date | 10/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114114055 | NPI | - | NPPES |
| 1326031865 | Other | GA | NPI |
| 1891815924 | Other | GA | NPI |
| 1225021678 | Other | GA | NPI |
| 1750374294 | Other | GA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 056658 (Georgia) | Primary |
Ich Physician Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 134 Fleetwood Ave E, Willacoochee, GA 31650 Phone: 912-534-5142 Fax: 912-534-6120 |