Provider Demographics
NPI:1568645034
Name:CLINCH MEDICAL PRACTICE
Entity Type:Organization
Organization Name:CLINCH MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYS
Authorized Official - Prefix:
Authorized Official - First Name:KULDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-487-5053
Mailing Address - Street 1:360 COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-2675
Mailing Address - Country:US
Mailing Address - Phone:912-487-5053
Mailing Address - Fax:
Practice Address - Street 1:360 COURTLAND AVE
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-2675
Practice Address - Country:US
Practice Address - Phone:912-487-5053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH31562Medicare UPIN
GA11SCGBBMedicare PIN