Healthcare Provider Details

I. General information

NPI: 1407174675
Provider Name (Legal Business Name): GOOD SAMARITAN HEALTH & WELLNESS CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 SAMARITAN DR
JASPER GA
30143-1964
US

IV. Provider business mailing address

175 SAMARITAN DR
JASPER GA
30143-1964
US

V. Phone/Fax

Practice location:
  • Phone: 706-253-4673
  • Fax: 706-253-4675
Mailing address:
  • Phone: 706-253-4633
  • Fax: 706-253-4631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TAMMI W SORRELLS
Title or Position: CEO
Credential:
Phone: 770-815-0986