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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
GA | 003140047A | 05 |
Other Name | Type Code |
---|---|
KIDS HEALTH | Doing Business As Name - Organization |
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 |
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 |
Street Address |
303 SHIRLEY AVE STE B |
City | DOUGLAS |
State | GA |
Zip Code | 31533 |
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 Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
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 |
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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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.