Access Medical Clinic Georgia LLC
Organization Active NPI Rural Health Clinic/Center · Hawkinsville, GA
NPI 1174104657 · NPPES record last updated Sep 13, 2022
Key facts
- NPI
- 1174104657
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ACCESS MEDICAL CLINIC GEORGIA LLC
- Practice address
- 37 341 Byp
Hawkinsville, GA 31036-0000 - Phone
- (478) 845-4842
- Fax
- (833) 606-0577
- NPI assigned
- Apr 16, 2021
- Organization subpart
- No
Authorized official
- Name
- Monya York
- Title
- Controller
- Phone
- (870) 856-1202
Owners & managing parties with NPI records 2
-
Randi L Davis, APRN
-
Mark S Hahn, DO
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 3
Practitioners 23
-
Janelle Brown, APRN-CNP
-
Ronda Arline, FNP
-
Cori Beth Sutton Brown, FNP-C
-
Terri Rae Cater, FNP-BC
-
Laura Day, FNP-BC
-
Lauren Goforth Faulk, APRN, FNP-C
-
Heather Franklin, MSN-FNP-C
-
Tyler Yvonne Jacobs, APRN
-
Jason Edward Jones, DNP, APRN, FNP-BC
-
Richard Steven Keene, NP-C
-
Mia Denise Pickard, BC-FNP
-
Darl Wayne Rantz, M.D.
-
Misty Michelle Schales, FNP-BC
-
Shelby Walker, APRN
-
Kimberly Lashon Williams, APRN, MSN, FNP-BC
-
Kaleise Tennille, APRN
-
Whitney Iman Thomas, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Rural health clinic certification: CCN 118917
- Legal name
- ACCESS MEDICAL CLINIC GEORGIA LLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 5, 2022
- Last certification
- Jan 5, 2022
- Ownership / control type
- 1C
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 11, 2021 in GA
- Enrollment address
- 37 341 Byp
Hawkinsville, GA 31036-4839
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Howard Freeman |
Corporate Director |
May 19, 2026 | |
| W-2 Managing Employee |
May 19, 2026 | ||
| Operational/Managerial Control |
May 19, 2026 | ||
| Mark Hahn |
5% Or Greater Direct Ownership Interest | May 8, 2025 | 100% |
| Corporate Director |
May 8, 2025 | ||
| Tony D James |
Corporate Officer |
May 19, 2026 | |
| W-2 Managing Employee |
May 19, 2026 | ||
| Jared Clifford |
Corporate Officer |
May 19, 2026 | |
| W-2 Managing Employee |
May 8, 2025 | ||
| Monya York |
Corporate Director |
May 8, 2025 | |
| W-2 Managing Employee | May 8, 2025 | ||
| Randi L Davis |
Corporate Director |
May 19, 2026 | |
| W-2 Managing Employee |
May 8, 2025 | ||
| Operational/Managerial Control |
May 19, 2026 | ||
| Kasey Crawford |
Corporate Director |
May 19, 2026 | |
| W-2 Managing Employee |
May 19, 2026 | ||
| Operational/Managerial Control |
May 19, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201222000083 | GA | Part B Supplier - Clinic/Group Practice | 2961814694 |
Receives reassigned benefits from 21 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brunswick, GA; Hawkinsville, GA; Perry, GA; Sylvester, GA |
| O20211123003251 | GA | Part a Provider - Rural Health Clinic | 2961814694 | Practice locations: Hawkinsville, GA |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/22235/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
37 341 Byp
Hawkinsville, GA 31036-0000
Mailing address
4196 Highway 62 412 Ste a
Hardy, AR 72542-8002
Other names
- Access Medical Clinic
Other providers in Hawkinsville, GA
- A & D Pharmacy, LLC
- Affinis Hospice, LLC
- Crystal Carroll Allen
- Amedisys Georgia L.L.C.
- American Professional Associates LLC
- Sherquon Quatavis Anderson
All providers in Hawkinsville, GA · Rural Health Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.