Provider Demographics
NPI:1114450665
Name:PHOEBE PRIMARY CARE OF CAMILLA
Entity Type:Organization
Organization Name:PHOEBE PRIMARY CARE OF CAMILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-565-9403
Mailing Address - Street 1:500 W 3RD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1900
Mailing Address - Country:US
Mailing Address - Phone:229-312-5802
Mailing Address - Fax:229-312-5885
Practice Address - Street 1:48 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1960
Practice Address - Country:US
Practice Address - Phone:229-336-5208
Practice Address - Fax:229-336-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care