| East Albany Pediatric & Adolescent Center | |
|
1712-c East Broad Avenue Albany GA 31705 | |
| (229) 639-3103 | |
| (229) 888-8935 |
| Full Name | East Albany Pediatric & Adolescent Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1712-c East Broad Avenue, Albany, Georgia |
| Authorized Official Name and Position | Shelley Spires (CEO) |
| Authorized Official Contact | 2298886559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Albany Pediatric & Adolescent Center Po Box 50098 Albany GA 31703-0098 Ph: (229) 639-3103 | East Albany Pediatric & Adolescent Center 1712-c East Broad Avenue Albany GA 31705 Ph: (229) 639-3103 |
| NPI Number | 1346265550 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 10/15/2015 |
| Medicare PECOS PAC ID | 7911811922 |
|---|---|
| Medicare Enrollment ID | O20041101000795 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346265550 | NPI | - | NPPES |
| 267797696A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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