Healthcare Provider Details

I. General information

NPI: 1568379121
Provider Name (Legal Business Name): SOUTH CENTRAL PRIMARY CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 BENJAMIN H HILL DR SW STE B
FITZGERALD GA
31750-8696
US

IV. Provider business mailing address

299 BENJAMIN H HILL DR SW STE B
FITZGERALD GA
31750-8696
US

V. Phone/Fax

Practice location:
  • Phone: 229-468-9166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BONDS TUCKER JR.
Title or Position: CEO
Credential:
Phone: 229-468-9166