| Willacoochee Clinic | |
|
134 Fleetwood Ave E Willacoochee GA 31650-2730 | |
| (912) 534-5142 | |
| (912) 534-6120 |
| Full Name | Willacoochee Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 134 Fleetwood Ave E, Willacoochee, Georgia |
| Authorized Official Name and Position | Krystal Carver (CFO) |
| Authorized Official Contact | 2294683846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willacoochee Clinic 710 N Irwin Ave Ocilla GA 31774-5011 Ph: (229) 468-3800 | Willacoochee Clinic 134 Fleetwood Ave E Willacoochee GA 31650-2730 Ph: (912) 534-5142 |
| NPI Number | 1649670894 |
|---|---|
| Provider Enumeration Date | 08/25/2014 |
| Last Update Date | 02/27/2025 |
| Certification Date | 02/27/2025 |
| Medicare PECOS PAC ID | 9537592084 |
|---|---|
| Medicare Enrollment ID | O20220316003013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649670894 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Secondary |
| 261QR1300X | Clinic/center - Rural Health | () | Primary |
Douglas Medical Specialist Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 134 E Fleetwood Ave, Willacoochee, GA 31650 Phone: 912-384-3338 Fax: 912-383-6365 |