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NPI Code Detail

MEDICARE: ARC OF GEORGIA, LLC

MEDICARE: ARC OF GEORGIA, 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
1261QA1903XAmbulatory Surgical Clinic/CenterK826642GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225023021
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARC OF GEORGIA, LLC
Provider Business Mailing Address
First Line : 3243 GLYNN AVE
Second Line :
City : BRUNSWICK
State : GA
Zip : 31520-4851
Country : US
Telephone Number : 912-264-9029
Fax Number : 912-264-1085
Provider Business Practice Location Address
First Line : 3243 GLYNN AVE
Second Line :
City : BRUNSWICK
State : GA
Zip : 31520-4851
Country : US
Telephone Number : 912-264-9029
Fax Number : 912-264-1085
Authorized Official
Title or Position : OFFICER AND AUTHORIZED OFFICIAL
Name : JENNIFER BOYD BALDOCK
Credential :
Telephone Number : 615-234-5900
Provider Enumeration Date : 09/18/2005
Last Update Date : 09/29/2020

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Directions to “ARC OF GEORGIA, LLC ” Practice Location

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