SOUTH CENTRAL PRIMARY CARE CENTER, INC. (NPI# 1669085742) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669085742 |
| Entity Type | Organization |
| Organization Name | SOUTH CENTRAL PRIMARY CARE CENTER, INC. |
| Practice Address |
159 Trojan Way Douglas GA 31533-8263 |
| Mailing Address |
Po Box 749 Ocilla GA 31774-0749 |
| Practice Telephone | 2294689166 |
| Practice Fax Number | 2294689188 |
| Mailing Telephone | 2294689166 |
| Mailing Fax Number | 2294689188 |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |
| Authorized Official Name | ROBERT BONDS TUCKER (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 |
|---|---|
| COFFEE COUNTY HIGH SCHOOL | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558445742 | South Central Primary Care Center, Inc. | Clinic/Center | 640 Main St N, Pearson, GA 31642 | 2006-10-24 |
| 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 |
159 TROJAN WAY |
| City | DOUGLAS |
| State | GA |
| Zip Code | 31533-8263 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215330279 | Benjamin Swafford | Specialist/Technologist | 159 Trojan Way, Douglas, GA 31533-8263 | 2014-10-06 |
| 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 |
| 1063840296 | South Central Primary Care Center | Clinic/Center | 303 Shirley Ave, Ste B, Douglas, GA 31533 | 2013-10-25 |
| 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 |
| 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 |
| 1063840296 | South Central Primary Care Center | Clinic/Center | 303 Shirley Ave, Ste B, Douglas, GA 31533 | 2013-10-25 |
| 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 |
| 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 |
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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 |
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| 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.