PRIMARY CARE OF SOUTHWEST GEORGIA INC. NPI 1780607754

NPI Information

NPI: 1780607754
Provider Name: PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
360 COLLEGE STREET
BLAKELY, GA
ZIP 39823
Phone: (229) 723-2660
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PRIMARY CARE OF SOUTHWEST GEORGIA, INC. is a federally qualified health center (fqhc) clinic center in Blakely, GA. PRIMARY CARE OF SOUTHWEST GEORGIA, INC. NPI is 1780607754. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

360 COLLEGE STREET
BLAKELY, GA
ZIP 39823
Phone: (229) 723-2660
Fax: (229) 723-2663

The provider's authorized official is Edwin V James .
The authorized official title is Chief Financial Officer and has the following contact phone number (229) 723-2660.

The enumeration date for this NPI number is 7/25/2006 and was last updated on 5/15/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	RN188412	GEORGIA	No
2	207R00000X	Internal Medicine		057747	GEORGIA	No
3	207Q00000X	Family Medicine		060068	GEORGIA	No
4	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	024893266A	MEDICAID	GEORGIA
2	GRP7568	MEDICARE PIN
3	111893	MEDICARE OSCAR/CERTIFICATION	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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