MEDICARE: SCARBOROUGH FAMILY MEDICINE

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	048078	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	:	1609082007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCARBOROUGH FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	4310 HARTLEY BRIDGE RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31216-5642
Country	:	US
Telephone Number	:	478-788-4007
Fax Number	:	478-788-5070

Provider Business Practice Location Address
First Line	:	4310 HARTLEY BRIDGE RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31216-5642
Country	:	US
Telephone Number	:	478-788-4007
Fax Number	:	478-788-5070

Authorized Official
Title or Position	:	OWNER
Name	:	CAMEKA N SCARBOROUGH
Credential	:	MD
Telephone Number	:	478-788-4007

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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