| Patrice D Boddie | |
|
240 N Wayne St Milledgeville GA 31061-3438 | |
| (478) 452-6999 | |
| (478) 452-7222 |
| Full Name | Patrice D Boddie |
|---|---|
| Speciality | Internal Medicine |
| Location | 240 N Wayne St, Milledgeville, Georgia |
| Authorized Official Name and Position | Patrice Boddie (PHYSICIAN/OWNER) |
| Authorized Official Contact | 4784526999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Patrice D Boddie 240 N Wayne St Milledgeville GA 31061-3438 Ph: (478) 452-6999 | Patrice D Boddie 240 N Wayne St Milledgeville GA 31061-3438 Ph: (478) 452-6999 |
| NPI Number | 1194151498 |
|---|---|
| Provider Enumeration Date | 09/18/2013 |
| Last Update Date | 02/05/2021 |
| Medicare PECOS PAC ID | 5496033607 |
|---|---|
| Medicare Enrollment ID | O20210205000101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194151498 | NPI | - | NPPES |
| 27966 | Other | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 027966 (Georgia) | Primary |
| Provider Name | Patrice D Boddie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376530774 PECOS PAC ID: 3971774118 Enrollment ID: I20110920000838 |
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