MEDICARE: BADIA MEDICAL, LLC

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

General Provider Information

NPI Number	:	1144025784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BADIA MEDICAL, LLC

Provider Business Mailing Address
First Line	:	107 PEACOCK DR
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-3637
Country	:	US
Telephone Number	:	478-922-3074
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 W DYKES ST
Second Line	:
City	:	COCHRAN
State	:	GA
Zip	:	31014-6921
Country	:	US
Telephone Number	:	478-922-3074
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ASHLEY DEFORE
Credential	:
Telephone Number	:	478-922-3074

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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