EAST GEORGIA HEALTHCARE CENTER, INC. (NPI# 1821126400) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821126400 |
| Entity Type | Organization |
| Organization Name | EAST GEORGIA HEALTHCARE CENTER, INC. |
| Other Organization Name | STATESBORO PEDIATRICS AND FAMILY HEALTHCARE CENTER |
| Practice Address |
1570 Brampton Ave Statesboro GA 30458-0855 |
| Mailing Address |
215 N Coleman St Swainsboro GA 30401-3530 |
| Practice Telephone | 9127649196 |
| Practice Fax Number | 9127648401 |
| Mailing Telephone | 4782376262 |
| Mailing Fax Number | 4782379138 |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2015-02-16 |
| Authorized Official Name | MRS. LINDA BRASWELL (OPERATIONS MANGER) |
| 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 | 861815107A | 05 |
| Other Name | Type Code |
|---|---|
| Statesboro Pediatrics and Family Healthcare Center | Doing Business As Name - Organization |
| 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 |
| 1700820917 | East Georgia Healthcare Center, Inc. | Clinic/Center | 452 Second St, Soperton, GA 30457-3004 | 2006-06-16 |
| 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 |
| 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 |
1570 BRAMPTON AVE |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-0855 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457441644 | Cindy O'bryant Gartmond | Pediatrics | 1570 Brampton Ave, Statesboro, GA 30458-0855 | 2006-10-16 |
| 1982168415 | Loretta Church | Physician Assistant | 1570 Brampton Ave, Statesboro, GA 30458-0855 | 2019-01-29 |
| 1023247731 | Sreevalli Dega | Family Medicine | 1570 Brampton Ave, Statesboro, GA 30458-0855 | 2009-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| 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 |
|---|---|---|---|---|
| 1225364524 | East Georgia Healthcare Center Inc | Clinic/Center | 1570 Brampton Avenue, Statesboro, GA 30458-0855 | 2009-10-22 |
| 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 |
| Find all providers with the same taxonomy | ||||
| City | STATESBORO |
| Zip Code | 30458 |
Please comment or provide details below to improve the information on EAST GEORGIA HEALTHCARE CENTER, INC..
| 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.