MEDICARE: THE NIGHTINGALE CLINIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	039500	GA

General Provider Information

NPI Number	:	1013059708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NIGHTINGALE CLINIC, PC

Provider Business Mailing Address
First Line	:	PO BOX 845
Second Line	:
City	:	QUITMAN
State	:	GA
Zip	:	31643-0845
Country	:	US
Telephone Number	:	229-263-8888
Fax Number	:	229-263-6528

Provider Business Practice Location Address
First Line	:	606 W SCREVEN ST
Second Line	:
City	:	QUITMAN
State	:	GA
Zip	:	31643-1922
Country	:	US
Telephone Number	:	229-263-8888
Fax Number	:	229-263-6528

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. JANET BARBER
Credential	:
Telephone Number	:	229-263-8888

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	03/30/2009

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