| Pavo Primary Care Clinic | |
|
1103 North Main Street Pavo GA 31778 | |
| (229) 859-2622 | |
| (229) 859-2885 |
| Full Name | Pavo Primary Care Clinic |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 1103 North Main Street, Pavo, Georgia |
| Authorized Official Name and Position | Charles D. Hightower (CFO) |
| Authorized Official Contact | 2292282853 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pavo Primary Care Clinic 920 Cairo Rd Thomasville GA 31792-4255 Ph: (229) 228-8800 | Pavo Primary Care Clinic 1103 North Main Street Pavo GA 31778 Ph: (229) 859-2622 |
| NPI Number | 1932296811 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 05/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932296811 | NPI | - | NPPES |
| 000000063H | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 136-91 (Georgia) | Primary |