Provider Demographics
NPI:1538191580
Name:PALMER CLINIC PC
Entity type:Organization
Organization Name:PALMER CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:478-289-0007
Mailing Address - Street 1:PO BOX 4048
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4048
Mailing Address - Country:US
Mailing Address - Phone:478-477-4818
Mailing Address - Fax:478-474-5553
Practice Address - Street 1:131C VICTORY DRIVE
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401
Practice Address - Country:US
Practice Address - Phone:478-289-0007
Practice Address - Fax:478-289-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADC0633OtherRAILROAD MCARE GROUP #
GADC0633OtherRAILROAD MCARE GROUP #