Organization
HEART OF GEORGIA PRIMARY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY H CRAVEY FNP-C (OWNER)
(478) 374-5774
Entity
Organization
Contact information
Practice address
911 PLAZA AVE STE C, EASTMAN, GA 31023-6786
(478) 374-5774
Mailing address
911 PLAZA AVE STE C, EASTMAN, GA 31023-6786
(478) 374-5774
(912) 374-9112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
296546508F
—
GA
01
—
CS2005900319
CARESOURCE PROVIDER NUMBER
GA
Enumeration date
06/17/2019
Last updated
02/23/2022
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