Provider Demographics
NPI:1124502489
Name:QFFCC AMERICUS LLC
Entity type:Organization
Organization Name:QFFCC AMERICUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-928-2299
Mailing Address - Street 1:2601 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1664
Mailing Address - Country:US
Mailing Address - Phone:229-405-8900
Mailing Address - Fax:
Practice Address - Street 1:116 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3508
Practice Address - Country:US
Practice Address - Phone:229-928-2299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care