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General NPI Number Information
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NPI Number | 1689743866
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Entity Type | Organization
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Legal Business Name | SUMTER PRIMARY CARE PC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 202 MAYO STREET STE B
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City | AMERICUS
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State | GA
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Zip | 31709
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Country | US
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Telephone | 229-931-9202
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Fax | 229-931-9206
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Provider Business Mailing Address
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Address Line | PO BOX 408
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City | AMERICUS
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State | GA
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Zip | 31709
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Country | US
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Telephone | 229-931-9202
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Fax | 229-931-9206
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AUDREY M HODGE
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Credential | MD
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Telephone | 229-931-9202
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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 | 049421
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License Number State | GA
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