| F.m.a., P.a. | |
|
522 College Ave Suite 1 Clemson SC 29631-1443 | |
| (864) 654-7841 | |
| (864) 654-7641 |
| Full Name | F.m.a., P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 522 College Ave, Clemson, South Carolina |
| Authorized Official Name and Position | Warren Douglas Gentry (PRESIDENT) |
| Authorized Official Contact | 8646547841 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| F.m.a., P.a. 522 College Ave Suite 1 Clemson SC 29631-1443 Ph: (864) 654-7841 | F.m.a., P.a. 522 College Ave Suite 1 Clemson SC 29631-1443 Ph: (864) 654-7841 |
| NPI Number | 1053426353 |
|---|---|
| Provider Enumeration Date | 08/20/2006 |
| Last Update Date | 08/08/2012 |
| Medicare PECOS PAC ID | 7810926052 |
|---|---|
| Medicare Enrollment ID | O20050809000231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053426353 | NPI | - | NPPES |
| 24081 | Other | SC | DR. TOLBERT STATE LICENSE |
| 9992 | Other | SC | GENTRY STATE LICENSE |
| PC3475 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 9992 (South Carolina) | Primary |
| Provider Name | Warren Douglas Gentry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598825739 PECOS PAC ID: 3173552312 Enrollment ID: I20101112000501 |
| Provider Name | Katrina Sharpe Maxwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851724272 PECOS PAC ID: 9133426984 Enrollment ID: I20160323000286 |
Redfern Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 735 Mcmillan Rd, Clemson, SC 29634 Phone: 864-656-0692 | |
Clemson Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 885 Tiger Blvd, Clemson, SC 29631 Phone: 864-654-6800 Fax: 864-654-7672 | |
Prisma Health-upstate Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 450 Old Greenville Hwy, Clemson, SC 29631 Phone: 864-653-8964 Fax: 864-653-8963 | |
Greenville Health System Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 208 Frontage Rd Ste 1, Clemson, SC 29631 Phone: 864-654-6034 Fax: 864-654-0342 | |
Clemson University-redfern Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 735 Mcmillan Rd, Clemson University, Clemson, SC 29634 Phone: 864-656-2233 Fax: 864-656-0760 | |
Anmed Health Clemson Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 885 Tiger Blvd, Clemson, SC 29631 Phone: 864-654-6800 |