Provider Demographics
NPI:1609138692
Name:MERCY MEDICAL CLINIC
Entity Type:Organization
Organization Name:MERCY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY WELLNESS DEPARTMENT DIREC
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:912-538-0523
Mailing Address - Street 1:300 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8935
Mailing Address - Country:US
Mailing Address - Phone:912-538-0523
Mailing Address - Fax:912-538-8945
Practice Address - Street 1:300 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8935
Practice Address - Country:US
Practice Address - Phone:912-538-0523
Practice Address - Fax:912-538-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN060662261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health