Healthcare Provider Details

I. General information

NPI: 1730793639
Provider Name (Legal Business Name): ACCESS MEDICAL CLINIC GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 08/25/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 N WESTBERRY ST
PERRY GA
31069-3145
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 229-463-7071
  • Fax: 833-606-0577
Mailing address:
  • Phone:
  • Fax: 870-856-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY BIBB
Title or Position: CEO
Credential: MD
Phone: 870-856-1202