Healthcare Provider Details

I. General information

NPI: 1093754905
Provider Name (Legal Business Name): EAST GEORGIA HEALTHCARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MEMORIAL DR
REIDSVILLE GA
30453-4641
US

IV. Provider business mailing address

215 N COLEMAN ST
SWAINSBORO GA
30401-3530
US

V. Phone/Fax

Practice location:
  • Phone: 912-557-3300
  • Fax: 912-557-3328
Mailing address:
  • Phone: 478-237-2638
  • Fax: 478-237-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JENNIE WREN DENMARK
Title or Position: CEO
Credential:
Phone: 478-237-2638