| Malozera Primary Care, Llc | |
|
2809 Pine St Unadilla GA 31091-7701 | |
| (478) 355-3000 | |
| (478) 355-3001 |
| Full Name | Malozera Primary Care, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2809 Pine St, Unadilla, Georgia |
| Authorized Official Name and Position | Alexander C Ibezi-enendu (OWNER) |
| Authorized Official Contact | 4047029466 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Malozera Primary Care, Llc P O Box 8203 Warner Robins GA 31095-8203 Ph: (478) 783-3610 | Malozera Primary Care, Llc 2809 Pine St Unadilla GA 31091-7701 Ph: (478) 355-3000 |
| NPI Number | 1912544784 |
|---|---|
| Provider Enumeration Date | 11/29/2019 |
| Last Update Date | 11/18/2023 |
| Medicare PECOS PAC ID | 4789010430 |
|---|---|
| Medicare Enrollment ID | O20200129000718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912544784 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Alexander C Ibezi-enendu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154615979 PECOS PAC ID: 3274832894 Enrollment ID: I20160706002548 |
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