| Golden Age Clinic | |
|
2901 Highway 82 E Greenwood MS 38930-2960 | |
| (662) 374-2185 | |
| (662) 374-2195 |
| Full Name | Golden Age Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2901 Highway 82 E, Greenwood, Mississippi |
| Authorized Official Name and Position | Tabatha Danielle Watkins (ADMINISTRATOR) |
| Authorized Official Contact | 6624536323 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Golden Age Clinic 2901 Highway 82 East Greenwood MS 38930-2960 Ph: (662) 374-2185 | Golden Age Clinic 2901 Highway 82 E Greenwood MS 38930-2960 Ph: (662) 374-2185 |
| NPI Number | 1558693671 |
|---|---|
| Provider Enumeration Date | 02/01/2010 |
| Last Update Date | 01/06/2022 |
| Medicare PECOS PAC ID | 0941294292 |
|---|---|
| Medicare Enrollment ID | O20100415000625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558693671 | NPI | - | NPPES |
| 09705072 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (Mississippi) | Primary |
| Provider Name | James E Warrington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912919234 PECOS PAC ID: 2769387901 Enrollment ID: I20031205000246 |
| Provider Name | Jacqueline Suszan Ware |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558670869 PECOS PAC ID: 3072791839 Enrollment ID: I20110624000564 |
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