OrganizationMcdonough Primary Care Inc(Keys Ferry Medical Center)Family MedicineAllopathic & Osteopathic PhysiciansPractice Address68 Hampton St, Mcdonough, GA 30253-3150(770) 914-0342PECOS EnrollmentBased on the most recent information from CMS, provider Mcdonough Primary Care Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:02 PM.Profile DetailsProvider ID1710058953Provider TypeOrganizationFull NameMcdonough Primary Care IncOther NameKeys Ferry Medical CenterSubpartNoEnumeration Date11/10/2006Last Updated11/9/2007Contact InformationPractice LocationPractice Address68 Hampton St, Mcdonough, GA 30253-3150Phone(770) 914-0342Fax(770) 914-0493Mailing LocationMailing Address68 Hampton St, Mcdonough, GA 30253-3150Phone(770) 914-0342Fax(770) 914-0493Authorized OfficialNameVan Laar, William Harrell (Owner)Phone(770) 914-0342Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID000458455EDescriptionMedicaidIssuerUnlistedGeorgia