Michael  W  Clifford    MD
Contract Details
Blakely Medical Group
Facility name
Provider ID
P000000315
NPI
1508800475
Tax ID
580910406
Effective Date
7/1/1995
Last Updated
11/21/2011
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
11168 Columbia St Suite B
Blakely, GA 39823
United States
County
Early
Phone
2297234313 (Phone)
Billing Details
Address
PO Box 547
Blakely, GA 398230547
Specialty Type
General Practice
Map
Address