Provider Demographics
NPI:1124049168
Name:WE CARE MEDICAL PRACTICE MD PC
Entity type:Organization
Organization Name:WE CARE MEDICAL PRACTICE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT WE CARE MEDICAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:JONES-FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-757-9705
Mailing Address - Street 1:420 CHARTER BLVD
Mailing Address - Street 2:STE 306
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:478-757-9705
Mailing Address - Fax:478-757-9365
Practice Address - Street 1:420 CHARTER BLVD
Practice Address - Street 2:STE 306
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-757-9705
Practice Address - Fax:478-757-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032926207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E74165Medicare UPIN
GA39BNBQ7Medicare ID - Type Unspecified