| Grace Medical Clinic | |
|
230 W College St B Griffin GA 30224-4121 | |
| (678) 688-1155 | |
| (678) 688-5071 |
| Full Name | Grace Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 230 W College St, Griffin, Georgia |
| Authorized Official Name and Position | Ehi Philip Osehobo (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6786881155 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Medical Clinic 230 W College St B Griffin GA 30224-4121 Ph: (678) 688-1155 | Grace Medical Clinic 230 W College St B Griffin GA 30224-4121 Ph: (678) 688-1155 |
| NPI Number | 1093887168 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 08/11/2010 |
| Medicare PECOS PAC ID | 4486674025 |
|---|---|
| Medicare Enrollment ID | O20051129000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093887168 | NPI | - | NPPES |
| 187778601A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 049075 (Georgia) | Primary |
| Provider Name | Ehi Philip Osehobo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639146293 PECOS PAC ID: 6103846746 Enrollment ID: I20101108000748 |
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