Provider Demographics
NPI:1144322306
Name:CLARKE COUNTY MEDICAL GROUP LLC
Entity type:Organization
Organization Name:CLARKE COUNTY MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER CRNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-636-5311
Mailing Address - Street 1:3050 HIGHWAY 5
Mailing Address - Street 2:UNIT 134
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-4325
Mailing Address - Country:US
Mailing Address - Phone:334-636-5311
Mailing Address - Fax:334-636-2280
Practice Address - Street 1:3050 HIGHWAY 5
Practice Address - Street 2:UNIT 134
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-4325
Practice Address - Country:US
Practice Address - Phone:334-636-5311
Practice Address - Fax:334-636-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL013934Medicare Oscar/Certification