Tri-County Clinic, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

GA030580 Issued in GA

Legal business name

TRI-COUNTY CLINIC, INC.

Practice address

551 N Cherokee Rd
Social Circle, GA 30025-2887

Phone

(770) 464-4434

Fax

(770) 464-4424

NPI assigned

Jun 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jan M Bennett, D.O.

Title

Owner

Phone

(770) 464-4434

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1801093497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "551 N CHEROKEE RD",
            "city": "SOCIAL CIRCLE",
            "state": "GA",
            "postal_code": "300252887",
            "telephone_number": "770-464-4434",
            "fax_number": "770-464-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 N CHEROKEE RD",
            "city": "SOCIAL CIRCLE",
            "state": "GA",
            "postal_code": "300252887",
            "telephone_number": "770-464-4434",
            "fax_number": "770-464-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-28",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-464-4434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "GA030580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000366638K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Social Circle Pharmacy and Supplies Inc.
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• Lanissa Rae Stinehelfer, FNP-BC
• Nicholas Ryan Tedrow, MD
• Triple a Non Emergency Transportation LLC
• Laura Lee Wahl, OTR
• Marilyn Elaine Sims Whitening, APRN-C
• Calandra Burke Young, LMSW
• Esther K Zwemer, PHYSICAL THERAPIST

• Family Medicine Physician in Social Circle, GA
• Providers in Social Circle, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.