| Southern Crescent Primary Care | |
|
7823 Spivey Station Blvd Suite 210 Jonesboro GA 30236-2886 | |
| (678) 610-2916 | |
| (678) 610-2925 |
| Full Name | Southern Crescent Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 7823 Spivey Station Blvd, Jonesboro, Georgia |
| Authorized Official Name and Position | John Olubusola Ogundipe (PHYSICIAN/PRESIDENT) |
| Authorized Official Contact | 6786102916 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Crescent Primary Care 7823 Spivey Station Blvd Suite 210 Jonesboro GA 30236-2886 Ph: (678) 610-2916 | Southern Crescent Primary Care 7823 Spivey Station Blvd Suite 210 Jonesboro GA 30236-2886 Ph: (678) 610-2916 |
| NPI Number | 1922267129 |
|---|---|
| Provider Enumeration Date | 06/03/2008 |
| Last Update Date | 06/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922267129 | NPI | - | NPPES |
| 000639768B | Medicaid | GA | |
| 110239410 | Other | GA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 039193 (Georgia) | Primary |
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