Organization
BACCHUS OPERATIONS GROUP, INC.
Active
Other names
Flint River Rural Health Clinic - Ellaville
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP H EASTMAN III (CHIEF EXECUTIVE OFFICER)
(478) 472-3100
Entity
Organization
Contact information
Practice address
509 SUMTER STREET, MONTEZUMA, GA 31063-1733
(478) 472-3100
(478) 472-2412
Mailing address
509 SUMTER STREET, PO BOX 770, MONTEZUMA, GA 31063-1733
(478) 472-3100
(478) 472-2412
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
094-391
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000149487B
—
GA
Enumeration date
12/08/2006
Last updated
03/23/2012
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