SOUTH CENTRAL PRIMARY CARE CENTER


Address: 303 Shirley Ave, Ste B, Douglas, GA 31533
Phone: 9123842474

SOUTH CENTRAL PRIMARY CARE CENTER (NPI# 1063840296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1063840296
Entity Type Organization
Organization Name SOUTH CENTRAL PRIMARY CARE CENTER
Other Organization Name KIDS HEALTH
Practice Address 303 Shirley Ave
Ste B
Douglas
GA 31533
Mailing Address 204 E 4th St
P O Box 749
Ocilla
GA 31774-1539
Practice Telephone 9123842474
Practice Fax Number 9123844995
Mailing Telephone 2294689166
Mailing Fax Number 2294689188
Enumeration Date 2013-10-25
Last Update Date 2016-09-19
Authorized Official Name MR. ROBERT B TUCKER JR. (CEO)
Authorized Official Telephone 2294689166
Authorized Official Credential CEO
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QF0400X Clinic/Center
Specialization: Federally Qualified Health Center (FQHC)
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
GA 003140047A 05

Other Provider/Organization Names

Other Name Type Code
KIDS HEALTH Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1538390729 South Central Primary Care Center Clinic/Center 610 N Irwin Ave, Ocilla, GA 31774-0749 2009-08-05
1376624569 South Central Primary Care Center Clinic/Center 357 Cargile Rd, Ocilla, GA 31774 2006-10-17
1649356981 South Central Primary Care Center Clinic/Center 200 S Cherry St, Ocilla, GA 31774 2006-10-30

Other Data Sources

Entity Type Entity Name Entity Address
System for Award Management (SAM) Entities SOUTH CENTRAL PRIMARY CARE CENTER, INC. 204 E 4th St, Ocilla, GA 31774-1539

Office Location

Street Address 303 SHIRLEY AVE
STE B
City DOUGLAS
State GA
Zip Code 31533

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1508470964 Swain Drug Company LLC Pharmacy 855 Bowens Mill Rd Sw Suite E, Douglas, GA 31533 2020-09-03
1811528649 Unison Behavioral Health Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 211 North Street, Douglas, GA 31533 2020-01-30
1952940793 Teresa Smith Pharmacist 901 W Ward St, Douglas, GA 31533 2019-12-26
1447641048 Jennifer Spivey Nurse Practitioner 326 Shirley Avenue, Douglas, GA 31533 2015-02-18
1972914497 Jessica Lynne Courson Nurse Practitioner 903 West Ward Street, Suite B, Douglas, GA 31533 2014-05-19
1336411008 Unison Behavioral Health Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 118 Coweta Avenue South, Douglas, GA 31533 2012-01-27
1346482700 V and V Clinic Pediatrics 1020 West Bryan Street, Douglas, GA 31533 2009-04-01
1063650406 Jayla Snipes Bullock Speech-Language Pathologist 618 Bowens Mill Road Sw, Douglas, GA 31533 2009-01-22
1417112707 Southern Community Services Inc Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 315 S. Gaskin Ave, Douglas, GA 31533 2008-07-25
1043411648 Coffee County Center for Digestive Diseases LLC Clinic/Center 300 Shirley Avenue, Douglas, GA 31533 2007-05-30
Find all providers in zip 31533

Taxonomy Information

Taxonomy Code 261QF0400X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Federally Qualified Health Center (FQHC)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1811472665 Chiricahua Community Health Centers, Inc Clinic/Center 1151 16th Street, Douglas, AZ 85607 2018-09-27
1295236503 South Central Primary Care Center, Inc Clinic/Center 303 Shirley Ave Ste A, Douglas, GA 31533-2367 2018-02-22
1174820898 Chiricahua Community Health Centers, Inc Clinic/Center 815 15th Street, Douglas, AZ 85607 2011-02-15
1942241443 Chiricahua Community Health Centers, Inc Clinic/Center 1205 F. Avenue, Douglas, AZ 85607 2006-06-08
1669085742 South Central Primary Care Center, Inc. Clinic/Center 159 Trojan Way, Douglas, GA 31533-8263 2020-08-28
1770981813 South Central Primary Care Center, Inc. Clinic/Center 1309 Ocilla Rd, Suite A, Douglas, GA 31533-2209 2014-12-05
1831273028 South Central Primary Care Center, Inc. Clinic/Center 1309 Ocilla Rd, Suite A, Douglas, GA 31533 2006-10-24
1801821970 Chiricahua Community Health Centers, Inc Clinic/Center 1100 F Ave, Douglas, AZ 85607-1919 2006-07-11

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1891395620 Primary Health Care Center of Dade, Inc. Clinic/Center 8a Probasco Street Unit 214, Lafayette, GA 30728 2020-10-30
1366066243 Health Education Assessment and Leadership Inc Clinic/Center 225 Griffin St Nw, Atlanta, GA 30314-3917 2020-06-05
1851924377 Valley Healthcare System Clinic/Center 1458 Benning Dr, Columbus, GA 31903-2200 2020-02-13
1952941528 Curtis V. Cooper Primary Health Care, Inc Clinic/Center 400 E Broad St, Savannah, GA 31401-5104 2020-01-13
1023658523 Saint Joseph's Mercy Care Services, Inc. Clinic/Center 1407 Cobb Parkway Nw, Marietta, GA 30060-6546 2020-01-13
1467092221 Careconnect Health, Inc. Clinic/Center 130 N Lee St, Forsyth, GA 31029-2122 2020-01-09
1417597238 The Family Health Centers of Georgia, Inc Clinic/Center 19 John Maddox Dr Nw Ste B, Rome, GA 30165-1477 2020-01-09
1649810714 Careconnect Health, Inc. Clinic/Center 254 Wright Avenue, Roberta, GA 31078 2020-01-07
1437798725 Careconnect Health, Inc. Clinic/Center 414 S Frontage Rd Lot 53, Forsyth, GA 31029-3025 2020-01-03
1285277608 Saint Joseph's Mercy Care Services, Inc. Clinic/Center 1976 Flat Shoals Rd Se Ste B, Atlanta, GA 30316-2857 2019-10-18
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Competitor

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City DOUGLAS
Zip Code 31533

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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