MCKINNEY MEDICAL CENTER INC (NPI# 1821476193) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821476193 |
| Entity Type | Organization |
| Organization Name | MCKINNEY MEDICAL CENTER INC |
| Other Organization Name | MCKINNEY MEDICAL CENTER, INC |
| Practice Address |
711 Charles Gilman Jr Ave Ste B Kingsland GA 31548-5664 |
| Mailing Address |
218 Quarterman St Waycross GA 31501-3547 |
| Practice Telephone | 9125109728 |
| Mailing Telephone | 9122870301 |
| Mailing Fax Number | 9122871568 |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2019-06-05 |
| Authorized Official Name | OLA SMITH (CEO) |
| Authorized Official Telephone | 9122870301 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | Y |
| Parent Organization Name | MCKINNEY MEDICAL CENTER INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
K408492 | GA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| McKinney Community Health Center | Doing Business As Name - Organization |
| MCKINNEY MEDICAL CENTER, INC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578822433 | Mckinney Medical Center Inc | Clinic/Center | 935 Mcdonald St, Waycross, GA 31501-4651 | 2012-05-14 |
| 1871756049 | Mckinney Medical Center Inc | Clinic/Center | 9355 South Main Street, Nahunta, GA 31553-9806 | 2008-07-08 |
| 1801057690 | Mckinney Medical Center Inc | Clinic/Center | 3919 Main St, Folkston, GA 31537-7545 | 2008-06-24 |
| 1487665733 | Mckinney Medical Center Inc | Clinic/Center | 218 Quarterman St, Waycross, GA 31501 | 2006-08-11 |
| 1134454911 | Mckinney Medical Center Inc | Clinic/Center | 501 N Pierce St, Alma, GA 31510-2445 | 2009-10-12 |
| Street Address |
711 CHARLES GILMAN JR AVE STE B |
| City | KINGSLAND |
| State | GA |
| Zip Code | 31548-5664 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629294665 | Mary E Lott | Pediatrics | 711 Charles Gilman Jr Ave Ste B, Kingsland, GA 31548-5664 | 2007-04-18 |
| 1700269958 | Courtney Marie Popwell | Nurse Practitioner | 711 Charles Gilman Jr Ave Ste B, Kingsland, GA 31548-5664 | 2015-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356984611 | Shelby Nichole Gambill | Nurse Practitioner | 103 Lake Palms Dr, Kingsland, GA 31548 | 2019-10-18 |
| 1629536339 | The Behavior Placellc | Behavior Technician | 103 Johansen Way, Kingsland, GA 31548 | 2019-03-12 |
| 1588020234 | Keywanna Nichole Price | Nurse Practitioner | 571 Henrietta St, Kingsland, GA 31548 | 2016-01-11 |
| 1083086243 | Sorinity Support Services, LLC | Nurse's Aide | 801 Hwy 40 East Ste A-139, Kingsland, GA 31548 | 2015-10-28 |
| 1740661594 | Briana Gray | Family Medicine | 1375 E King Ave Ste B, Kingsland, GA 31548 | 2015-06-17 |
| 1649670530 | Kimberly Grande | Physical Therapist | 100 B Lindsey Lane, Kingsland, GA 31548 | 2014-08-27 |
| 1598044307 | Margaret Peek Powell | Counselor | 100 Mariners Dr. Suite D, Kingsland, GA 31548 | 2011-08-10 |
| 1376850545 | Heavenly Devine Blessing | Home Delivered Meals | 105 North Lee Street, Kingsland, GA 31548 | 2010-09-08 |
| 1053649657 | Melissa Anne White | Nurse Practitioner | 701 Charles Gilman Jr Ave Ste B, Kingsland, GA 31548 | 2009-11-20 |
| 1629203690 | Genevieve Matherne | Occupational Therapist | 100b Lindsey Lane, Kingsland, GA 31548 | 2009-05-20 |
| Find all providers in zip 31548 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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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.