EAST GEORGIA HEALTHCARE CENTER, INC. (NPI# 1700820917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700820917 |
| Entity Type | Organization |
| Organization Name | EAST GEORGIA HEALTHCARE CENTER, INC. |
| Practice Address |
452 Second St Soperton GA 30457-3004 |
| Mailing Address |
128 S Main St Swainsboro GA 30401-3618 |
| Practice Telephone | 9125295533 |
| Practice Fax Number | 9125295535 |
| Mailing Telephone | 4782376262 |
| Mailing Fax Number | 4782376221 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2010-08-25 |
| Authorized Official Name | JENNIE WREN DENMARK (CEO) |
| Authorized Official Telephone | 4782376262 |
| 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 | 000632376G | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487892857 | East Georgia Healthcare Center, Inc. | Clinic/Center | 118 E Broad St, Mount Vernon, GA 30445-3018 | 2009-01-23 |
| 1821270323 | East Georgia Healthcare Center, Inc. | Clinic/Center | 34 Nw Broad St, Metter, GA 30439-4025 | 2007-11-27 |
| 1093754905 | East Georgia Healthcare Center, Inc. | Clinic/Center | 117 Memorial Dr, Reidsville, GA 30453-4641 | 2006-06-06 |
| 1790924918 | East Georgia Healthcare Center, Inc. | Clinic/Center | 118 Alice Coleman Dr, Vidalia, GA 30474-8860 | 2009-02-11 |
| 1477738417 | East Georgia Healthcare Center, Inc. | Clinic/Center | 125b Victory Dr, Swainsboro, GA 30401-3234 | 2008-01-09 |
| 1821126400 | East Georgia Healthcare Center, Inc. | Clinic/Center | 1570 Brampton Ave, Statesboro, GA 30458-0855 | 2007-03-02 |
| 1831144971 | East Georgia Healthcare Center, Inc. | Clinic/Center | 215 N Coleman St, Swainsboro, GA 30401-3530 | 2006-05-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | EAST GEORGIA HEALTHCARE CENTER, INC. | 215 N Coleman St, Swainsboro, GA 30401-3530 |
| Street Address |
452 SECOND ST |
| City | SOPERTON |
| State | GA |
| Zip Code | 30457-3004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992933329 | Elisha A Plaxico | Nurse Practitioner | 452 Second St, Soperton, GA 30457-3004 | 2009-06-24 |
| 1750397527 | Carol C Simmons | Nurse Practitioner | 452 Second St, Soperton, GA 30457-3004 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144431479 | David Lavon Moore | General Practice | 4101 Cascade Circle, Soperton, GA 30457 | 2007-05-25 |
| 1588654388 | Emanuel County Hospital Authority | Clinic/Center | 601 Third St, Soperton, GA 30457 | 2005-10-24 |
| 1942303557 | Ernest Wesley Crowe | Pharmacist | 112 W Main St, Soperton Pharmacy Inc, Soperton, GA 30457 | 2006-09-07 |
| 1689707150 | Community Service Board of Middle Georgia | Community/Behavioral Health | 417 Louisiana Ave E, Soperton, GA 30457-1126 | 2007-03-14 |
| 1457467219 | Joel Scott Bray | Family Medicine | 601 3rd St N, Soperton, GA 30457-1160 | 2006-08-22 |
| 1184738429 | John Louis Pournelle Jr. | Dentist | 607 3rd St N, Soperton, GA 30457-1160 | 2006-08-17 |
| 1558339838 | Soperton Pharmacy, Inc | Durable Medical Equipment & Medical Supplies | 112 Main St W, Soperton, GA 30457-1169 | 2006-03-10 |
| 1952441180 | Richard Marion Dennard | Pharmacist | 119 2nd St N, Soperton, GA 30457-1177 | 2007-02-07 |
| 1215078969 | Adele Diane Dennard | Pharmacist | 119 2nd St N, Soperton, GA 30457-1177 | 2007-02-08 |
| 1316088040 | Blakely Sutton Dennard | Pharmacist | 119 2nd St N, Soperton, GA 30457-1177 | 2007-02-08 |
| Find all providers in zip 30457 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 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.