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SOUTH CENTRAL PRIMARY CARE CENTER INC. NPI 1982019253


NPI Information

NPI: 1982019253
Provider Name: SOUTH CENTRAL PRIMARY CARE CENTER, INC.

Doing Business As: SOUTH CENTRAL WOMEN'S HEALTH

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 11D2226636

Address:
119 NORMAN DORMINY DR
STE B
FITZGERALD, GA
ZIP 31750
Phone: (229) 426-7685
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SOUTH CENTRAL PRIMARY CARE CENTER, INC. is a federally qualified health center (fqhc) clinic center in Fitzgerald, GA. SOUTH CENTRAL PRIMARY CARE CENTER, INC. NPI is 1982019253. The provider is registered as an organization entity type.
The provider Is Doing Business As South Central Women's Health.

The provider's business location address is:

119 NORMAN DORMINY DR
STE B
FITZGERALD, GA
ZIP 31750-855
Phone: (229) 426-7685
Fax: (229) 426-7627

The provider's authorized official is Robert B Tucker .
The authorized official title is Ceo and has the following contact phone number (229) 468-9166.

The CLIA number assigned to this NPI record is 11D2226636 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/25/2014 and was last updated on 8/11/2022.


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
1261QF0400XClinic/CenterFederally 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 Other Provider Identifier Issuer
1003147925AMEDICAIDGEORGIA

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.