Provider Demographics
NPI:1063603298
Name:RHINE MEDICAL CLINIC INC
Entity type:Organization
Organization Name:RHINE MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-385-8822
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:RHINE
Mailing Address - State:GA
Mailing Address - Zip Code:31077-0188
Mailing Address - Country:US
Mailing Address - Phone:229-385-8822
Mailing Address - Fax:229-385-8828
Practice Address - Street 1:1310 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RHINE
Practice Address - State:GA
Practice Address - Zip Code:31077
Practice Address - Country:US
Practice Address - Phone:229-385-8822
Practice Address - Fax:229-385-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023247208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty