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General NPI Number Information
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NPI Number | 1093754905
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Entity Type | Organization
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Legal Business Name | EAST GEORGIA HEALTHCARE CENTER, INC.
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 117 MEMORIAL DR
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City | REIDSVILLE
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State | GA
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Zip | 30453-4641
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Country | US
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Telephone | 912-557-3300
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Fax | 912-557-3328
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Provider Business Mailing Address
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Address Line | 215 N COLEMAN ST
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City | SWAINSBORO
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State | GA
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Zip | 30401-3530
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Country | US
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Telephone | 478-237-2638
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Fax | 478-237-9138
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Authorized Official
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Title or Position | CEO
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Name | JENNIE WREN DENMARK
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Credential |
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Telephone | 478-237-2638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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