Organization
ICH PHYSICIAN GROUP
Active
Organization
ICH PHYSICIAN GROUP
Active
Other names
Willacoochee Clinic, IRWIN COUNTY HOSPITAL AUTHORITY
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL CARVER (CFO)
(229) 468-3846
Entity
Organization
Contact information
Practice address
134 FLEETWOOD AVE E, WILLACOOCHEE, GA 31650-2730
(912) 534-5142
(912) 534-6120
Mailing address
710 N IRWIN AVE, OCILLA, GA 31774-5011
(229) 468-3800
(229) 468-9991
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/25/2014
Last updated
02/27/2025
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