Provider Demographics
NPI:1609896885
Name:TOCCOA CLINIC MEDICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:TOCCOA CLINIC MEDICAL ASSOCIATES, LLP
Other - Org Name:LAVONIA CLINIC MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-886-7537
Mailing Address - Street 1:PO BOX 8848
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8848
Mailing Address - Country:US
Mailing Address - Phone:513-632-4885
Mailing Address - Fax:
Practice Address - Street 1:58 BIG A RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6000
Practice Address - Country:US
Practice Address - Phone:706-886-3148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1291Medicare PIN