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General NPI Number Information
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NPI Number | 1346648250
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Entity Type | Organization
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Legal Business Name | FREE CLINIC OF ROME GEORGIA INC
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 101-B JOHN MADDOX DRIVE
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City | ROME
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State | GA
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Zip | 30165-1419
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Country | US
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Telephone | 706-234-1331
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Fax |
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Provider Business Mailing Address
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Address Line | 101-B JOHN MADDOX DRIVE
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City | ROME
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State | GA
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Zip | 30165-1419
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Country | US
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Telephone | 706-234-1331
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Fax |
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Authorized Official
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Title or Position | EXEXCTUIVE DIRECTOR
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Name | BARBARA EARLE
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Credential |
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Telephone | 706-234-1331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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