Cordele Family Medicine PC
Organization Active NPI Family Medicine Physician · Cordele, GA
NPI 1659477404 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1659477404
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 22921 (GA)
- Legal business name
- CORDELE FAMILY MEDICINE PC
- Practice address
- 501 Third Avenue East
Cordele, GA 31015 - Phone
- (229) 273-0841
- Fax
- (229) 273-0841
- NPI assigned
- Sep 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Henry William Young, MD
- Title
- Physician
- Phone
- (229) 273-0841
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120705000553 | GA | Part B Supplier - Clinic/Group Practice | 6901061514 |
Receives reassigned benefits from 1 practitioner Practice locations: Cordele, GA |
National Provider Directory
Locations
501 E 3rd Ave
Cordele, GA 31015
Phone (229) 273-0841
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 22921 | GA | Yes |
Addresses
Primary practice location
501 Third Avenue East
Cordele, GA 31015
Mailing address
501 Third Avenue East
Cordele, GA 31015
Phone (229) 273-0841
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00265218A | Medicaid | GA |
Other providers in Cordele, GA
- April Coleene Coffee
- Derrick Deandre Collier
- Elizabeth Anne Cook
- Waretta Sawyer Cooks
- Cordele Dialysis Center LLC
- Cordele Health and Rehabilitation Center, Inc.
- Cordele Internal Medicine
- Cordele Optical Disp., Inc.
- Cordele Personal Care Home
- Monae Marie Cost
All providers in Cordele, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.