Doerun Primary Care Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DOERUN PRIMARY CARE CLINIC LLC

Practice address

204 N Broad St
Doerun, GA 31744

Phone

(229) 985-3320

Fax

(229) 890-1282

NPI assigned

Apr 7, 2023

Organization subpart

No

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

Authorized official

Name

Jayshree Bhavnani

Title

Cfo

Phone

(229) 891-9131

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1680825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690502400000",
    "number": "1891480653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2876",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762876",
            "telephone_number": "229-891-9131",
            "fax_number": "229-891-9130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 N BROAD ST",
            "city": "DOERUN",
            "state": "GA",
            "postal_code": "31744",
            "telephone_number": "229-985-3320",
            "fax_number": "229-890-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOERUN PRIMARY CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-07",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A",
        "authorized_official_last_name": "BHAVNANI",
        "authorized_official_first_name": "JAYSHREE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-891-9131"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Doerun, GA
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.