| Peachtree Family Medicine, Llc. | |
|
330 Peachtree St Jesup GA 31545-0246 | |
| (912) 415-8552 | |
| Not Available |
| Full Name | Peachtree Family Medicine, Llc. |
|---|---|
| Speciality | Family Medicine |
| Location | 330 Peachtree St, Jesup, Georgia |
| Authorized Official Name and Position | Jennifer Holly Jones (OWNER) |
| Authorized Official Contact | 9124158552 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peachtree Family Medicine, Llc. 1414 Ogden Loop Odum GA 31555 Ph: (912) 415-8552 | Peachtree Family Medicine, Llc. 330 Peachtree St Jesup GA 31545-0246 Ph: (912) 415-8552 |
| NPI Number | 1700608353 |
|---|---|
| Provider Enumeration Date | 10/25/2024 |
| Last Update Date | 12/04/2024 |
| Medicare PECOS PAC ID | 4183151582 |
|---|---|
| Medicare Enrollment ID | O20241226000272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700608353 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tandy Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457632721 PECOS PAC ID: 1850565888 Enrollment ID: I20111130000908 |
| Provider Name | Jennifer Holly Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407365265 PECOS PAC ID: 2567721798 Enrollment ID: I20180117000196 |
| Provider Name | Jose Salvador Reyes Oliva Md |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770978900 PECOS PAC ID: 7012251705 Enrollment ID: I20200902003245 |
| Provider Name | Kayla Mathie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609684331 PECOS PAC ID: 5193255859 Enrollment ID: I20250210003364 |
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