Organization
LAKE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA VIDAL (CEO)
(706) 453-7331
Entity
Organization
Contact information
Practice address
1201 SILOAM RD, GREENSBORO, GA 30642-2811
(706) 453-7331
(706) 453-2812
Mailing address
1201 SILOAM RD, GREENSBORO, GA 30642-2811
(706) 453-7331
(706) 453-2812
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
PENDING
GA
Other
Enumeration date
11/02/2006
Last updated
08/22/2020
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