Healthcare Provider Details

I. General information

NPI: 1518893833
Provider Name (Legal Business Name): BADIA MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 W DYKES ST
COCHRAN GA
31014-6921
US

IV. Provider business mailing address

179 W DYKES ST
COCHRAN GA
31014-6921
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-3074
  • Fax:
Mailing address:
  • Phone: 478-922-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHLEY DEFORE
Title or Position: MANAGER
Credential:
Phone: 478-922-3074