MEDICARE: ACCESS MEDICAL CLINIC 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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1730793639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS MEDICAL CLINIC GEORGIA LLC

Provider Business Mailing Address
First Line	:	4196 HIGHWAY 62 412 STE A
Second Line	:
City	:	HARDY
State	:	AR
Zip	:	72542-8002
Country	:	US
Telephone Number	:
Fax Number	:	870-856-2107

Provider Business Practice Location Address
First Line	:	304 N WESTBERRY ST
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-3145
Country	:	US
Telephone Number	:	229-463-7071
Fax Number	:	833-606-0577

Authorized Official
Title or Position	:	CEO
Name	:	BRADLEY BIBB
Credential	:	MD
Telephone Number	:	870-856-1202

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	08/25/2021

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