Healthcare Provider Details

I. General information

NPI: 1902028327
Provider Name (Legal Business Name): THE MEDICAL CLINICS OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W.COLLEGE STREET
BOWDON GA
30108-1311
US

IV. Provider business mailing address

425 W.COLLEGE STREET
BOWDON GA
30108-1311
US

V. Phone/Fax

Practice location:
  • Phone: 770-258-1002
  • Fax: 770-258-1003
Mailing address:
  • Phone: 770-258-1002
  • Fax: 770-258-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberGA040605
License Number StateGA

VIII. Authorized Official

Name: DR. JAMES KEITH BAILEY
Title or Position: CEO
Credential: M.D.
Phone: 770-258-1002