Doerun Family Medicine Clinic

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

DOERUN FAMILY MEDICINE CLINIC

Practice address

128 West Broad Ave
Doerun, GA 31744

Phone

(229) 891-9131

Fax

(229) 891-9079

NPI assigned

Jul 23, 2013

Last updated

May 7, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Wendell Larry Sims

Title

Cfo

Phone

(229) 985-3420

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430956800000",
    "number": "1992147573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 624",
            "city": "DOERUN",
            "state": "GA",
            "postal_code": "317440624",
            "telephone_number": "229-891-9131",
            "fax_number": "229-891-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 WEST BROAD AVE",
            "city": "DOERUN",
            "state": "GA",
            "postal_code": "31744",
            "telephone_number": "229-891-9131",
            "fax_number": "229-891-9079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOERUN FAMILY MEDICINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2015-05-07",
        "status": "A",
        "authorized_official_last_name": "SIMS",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_middle_name": "LARRY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-985-3420",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "11-8911",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003157266A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Apothecary Inc
• Doerun Healthcare L.L.C.
• Doerun Primary Care Clinic LLC
• Wendy Hayes, PP
• Highway to Heaven LLC
• Latoya Jackson

• Rural Health Clinic/Center in Doerun, GA
• Providers in Doerun, GA by specialty
• Rural Health Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; 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.