MEDICARE: MUNSAYAC MEDICAL CLINIC

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	261QP2300X	Primary Care Clinic/Center	015028	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1558354787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUNSAYAC MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 519
Second Line	:
City	:	LUMBER CITY
State	:	GA
Zip	:	31549-0519
Country	:	US
Telephone Number	:	912-363-4389
Fax Number	:	912-363-1377

Provider Business Practice Location Address
First Line	:	308 MAIN ST
Second Line	:
City	:	LUMBER CITY
State	:	GA
Zip	:	31549-9752
Country	:	US
Telephone Number	:	912-363-4389
Fax Number	:	912-363-1377

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LUMAWIG Y MUNSAYAC
Credential	:	M.D.
Telephone Number	:	912-363-4389

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	08/22/2020

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