SOUTH CENTRAL PRIMARY CARE CENTER, INC (NPI# 1639664303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639664303 |
| Entity Type | Organization |
| Organization Name | SOUTH CENTRAL PRIMARY CARE CENTER, INC |
| Other Organization Name | NORTHSIDE FAMILY HEALTH CENTER |
| Practice Address |
247 Northside Dr Ste B Valdosta GA 31602 |
| Mailing Address |
Po Box 749 Ocilla GA 31774-0749 |
| Practice Telephone | 2292531206 |
| Practice Fax Number | 2292531209 |
| Mailing Telephone | 2294689166 |
| Mailing Fax Number | 2294689188 |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-07-09 |
| Authorized Official Name | ROBERT B TUCKER JR. (CEO) |
| 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) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| NORTHSIDE FAMILY HEALTH CENTER | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467094649 | South Central Primary Care Center, Inc | Clinic/Center | 149 Chieftain Cir, Ocilla, GA 31774-2231 | 2019-10-09 |
| 1295236503 | South Central Primary Care Center, Inc | Clinic/Center | 303 Shirley Ave Ste A, Douglas, GA 31533-2367 | 2018-02-22 |
| 1356709646 | South Central Primary Care Center, Inc | Clinic/Center | 607c N Irwin Ave, Ocilla, GA 31774-5009 | 2016-02-02 |
| 1558447896 | South Central Primary Care Center, Inc | Clinic/Center | 602 N Irwin Ave Ste B, Ocilla, GA 31774-5040 | 2006-10-30 |
| 1528683885 | South Central Primary Care Center, Inc | Clinic/Center | 2707 N Forrest St, Valdosta, GA 31602-2057 | 2020-06-12 |
| 1568963858 | South Central Primary Care Center, Inc | Clinic/Center | 361 Cargile Rd, Ocilla, GA 31774-3606 | 2018-02-22 |
| 1548768625 | South Central Primary Care Center, Inc | Clinic/Center | 15 S Railroad St, Lenox, GA 31637-7424 | 2018-01-24 |
| 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 |
247 NORTHSIDE DR STE B |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164711313 | Travis Lee Bailey | Anesthesiology | 247 Northside Dr Ste B, Valdosta, GA 31602-1892 | 2011-03-28 |
| 1366859233 | Chinmay M Patel | Family Medicine | 247 Northside Dr Ste B, Valdosta, GA 31602 | 2014-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| 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 |
|---|---|---|---|---|
| 1528683885 | South Central Primary Care Center, Inc | Clinic/Center | 2707 N Forrest St, Valdosta, GA 31602-2057 | 2020-06-12 |
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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.