# TROOP MEDICAL CLINIC \#4

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588653158
- **Authorized official:** MR. PATRICK MICHAEL PARKS PHYSICIAN ASSISTANT (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (912) 435-5179

## Contact information

- **Practice address:** 1061 HARMON AVE, STE 1D03, WINN ARMY COMMUNITY HOSPITAL, FT. STEWART, GA 31314-5611
- **Practice address phone:** (912) 435-6933
- **Mailing address:** 92 BRITTANY CT, RICHMOND HILL, GA 31324-5184
- **Mailing address phone:** (912) 727-3073

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | 004529 | GA | Yes |

## Other

- **Enumeration date:** 10/17/2005
- **Last updated:** 08/22/2020