SOUTH CENTRAL PRIMARY CARE CENTER, INC. (NPI# 1558445742) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558445742 |
| Entity Type | Organization |
| Organization Name | SOUTH CENTRAL PRIMARY CARE CENTER, INC. |
| Other Organization Name | SOUTH CENTRAL FAMILY MEDICINE |
| Practice Address |
640 Main St N Pearson GA 31642 |
| Mailing Address |
406 W 5th St Ocilla GA 31774-1421 |
| Practice Telephone | 9124223131 |
| Practice Fax Number | 9124223180 |
| Mailing Telephone | 2294689166 |
| Mailing Fax Number | 2294689188 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-04-16 |
| Authorized Official Name | MR. ROBERT B TUCKER JR. (CFO) |
| Authorized Official Telephone | 2294689166 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000611663F | 05 |
| Other Name | Type Code |
|---|---|
| SOUTH CENTRAL FAMILY MEDICINE | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669085742 | South Central Primary Care Center, Inc. | Clinic/Center | 159 Trojan Way, Douglas, GA 31533-8263 | 2020-08-28 |
| 1568844991 | South Central Primary Care Center, Inc. | Clinic/Center | 201 N Bartow St, Nashville, GA 31639-1435 | 2015-06-22 |
| 1770981813 | South Central Primary Care Center, Inc. | Clinic/Center | 1309 Ocilla Rd, Suite A, Douglas, GA 31533-2209 | 2014-12-05 |
| 1982019253 | South Central Primary Care Center, Inc. | Clinic/Center | 119 Norman Dorminy Dr, Ste B, Fitzgerald, GA 31750-8855 | 2014-06-25 |
| 1295094340 | South Central Primary Care Center, Inc. | Clinic/Center | 119 Norman Dorminy Dr Ste A, Fitzgerald, GA 31750-8855 | 2012-05-10 |
| 1891978854 | South Central Primary Care Center, Inc. | Clinic/Center | 204 E 4th St, Ocilla, GA 31774-1539 | 2007-12-13 |
| 1831273028 | South Central Primary Care Center, Inc. | Clinic/Center | 1309 Ocilla Rd, Suite A, Douglas, GA 31533 | 2006-10-24 |
| 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 |
640 MAIN ST N |
| City | PEARSON |
| State | GA |
| Zip Code | 31642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760862346 | Amanda Carver Merritt | Nurse Practitioner | 640 Main St N, Pearson, GA 31642 | 2015-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528201936 | Asf Medical Center Inc | Emergency Medicine | 640 Main St North, Pearson, GA 31642 | 2009-04-15 |
| 1063657617 | Beverly Dianne Robertson | Registered Nurse | 636 A E. Austin Ave, Pearson, GA 31642 | 2008-12-11 |
| 1164569190 | Unison Behavioral Health | Day Training, Developmentally Disabled Services | 636 E Austin Ave, Suite 3, Pearson, GA 31642 | 2007-01-31 |
| 1154468106 | Unison Behavioral Health | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 104 W Austin Avenue, Pearson, GA 31642 | 2007-01-31 |
| 1750443263 | Atkinson County Board of Education | Registered Nurse | 98 East Roberts Ave., Pearson, GA 31642 | 2006-12-14 |
| 1578632931 | Boones Pharmacy, Inc. | Pharmacist | 37 Albany Ave E, Pearson, GA 31642 | 2006-11-07 |
| 1518062199 | Stephen Marcel Burt | General Practice | 1111 Highway 441 North, Pearson, GA 31642 | 2006-09-14 |
| 1922067859 | Rebecca A Clark | Physician Assistant | 664 N Main St, Pearson, GA 31642 | 2006-03-20 |
| 1962483867 | Ware Visiting Nurses Service, Inc | Home Health | 380 East Roberts St, Pearson, GA 31642 | 2005-11-08 |
| 1255895553 | Donna Kenyattia Wells | Contractor | 214 Broughton St, Pearson, GA 31642-7044 | 2019-01-31 |
| Find all providers in zip 31642 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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|---|---|---|---|---|
| 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 |
| Find all providers with the same taxonomy | ||||
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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.