Organization
DOERUN FAMILY MEDICINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WENDELL LARRY SIMS (CFO)
(229) 985-3420
Entity
Organization
Contact information
Practice address
128 WEST BROAD AVE, DOERUN, GA 31744
(229) 891-9131
(229) 891-9079
Mailing address
PO BOX 624, DOERUN, GA 31744-0624
(229) 891-9131
(229) 891-9079
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003157266A
—
GA
01
—
11-8911
MEDICARE PART A
GA
Enumeration date
07/23/2013
Last updated
05/07/2015
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