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Organization

SOUTHWEST GA PRIMARY CARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LINDA P HAMSLEY FNP-C (OWNER)
(229) 410-9965
Entity
Organization

Contact information

Practice address
93 S BROAD ST, ELLAVILLE, GA 31806-0989
(229) 410-9965
(229) 937-9007
Mailing address
PO BOX 989, ELLAVILLE, GA 31806-0989
(229) 410-9965
(229) 937-9007

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
33367
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000506437G
GA
Enumeration date
08/05/2013
Last updated
06/05/2014
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