MEDICARE: I V CARE OF MIDDLE GEORGIA INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1508620618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I V CARE OF MIDDLE GEORGIA INC

Provider Business Mailing Address
First Line	:	718 MEDICAL CENTER DR
Second Line	:
City	:	EASTMAN
State	:	GA
Zip	:	31023-6736
Country	:	US
Telephone Number	:	478-374-6662
Fax Number	:	478-374-6663

Provider Business Practice Location Address
First Line	:	72 KENT RD STE 7
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-1695
Country	:	US
Telephone Number	:	478-374-6662
Fax Number	:	478-374-6663

Authorized Official
Title or Position	:	CFO
Name	:	TAMMY T PETERSON
Credential	:
Telephone Number	:	478-374-6662

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	11/15/2024

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