| D/b/a Grady Primary Care | |
|
235 1st Ave Ne Cairo GA 39828-2118 | |
| (229) 378-2214 | |
| (833) 386-7012 |
| Full Name | D/b/a Grady Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 235 1st Ave Ne, Cairo, Georgia |
| Authorized Official Name and Position | Kimberly Ann Harbin (OWNER) |
| Authorized Official Contact | 2293782214 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| D/b/a Grady Primary Care 235 1st Ave Ne Cairo GA 39828-2118 Ph: (229) 378-2214 | D/b/a Grady Primary Care 235 1st Ave Ne Cairo GA 39828-2118 Ph: (229) 378-2214 |
| NPI Number | 1124638614 |
|---|---|
| Provider Enumeration Date | 08/09/2020 |
| Last Update Date | 09/02/2021 |
| Certification Date | 09/02/2021 |
| Medicare PECOS PAC ID | 0446679484 |
|---|---|
| Medicare Enrollment ID | O20200924002660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124638614 | NPI | - | NPPES |
| 0009544125 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| Provider Name | Alton K Dinkins |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1588627632 PECOS PAC ID: 8820063050 Enrollment ID: I20040831000715 |
| Provider Name | Lesley E Maples |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578566121 PECOS PAC ID: 5496720641 Enrollment ID: I20040831000852 |
| Provider Name | Cindy Caldwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407842925 PECOS PAC ID: 4183657919 Enrollment ID: I20050913000765 |
| Provider Name | Kimberly a Harbin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790731867 PECOS PAC ID: 0941203590 Enrollment ID: I20060821000303 |
| Provider Name | Jennifer T. Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871220905 PECOS PAC ID: 1951882984 Enrollment ID: I20260226003313 |
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