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General NPI Number Information
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NPI Number | 1225088529
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Entity Type | Organization
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Legal Business Name | JOHNSON COUNTY CENTER FOR COMMUNITY HEALTH
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 508 W ELM ST
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City | WRIGHTSVILLE
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State | GA
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Zip | 31096-1224
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Country | US
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Telephone | 478-864-3448
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Fax | 478-864-1288
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Provider Business Mailing Address
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Address Line | 508 W ELM ST
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City | WRIGHTSVILLE
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State | GA
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Zip | 31096-1224
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Country | US
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Telephone | 478-864-3448
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Fax | 478-864-1288
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Authorized Official
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Title or Position | INSURANCE SUPERVISOR
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Name | MRS. LYNN W PRICE
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Credential |
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Telephone | 478-864-3448
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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 | 054797
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License Number State | GA
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