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General NPI Number Information
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NPI Number | 1326594714
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Entity Type | Organization
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Legal Business Name | DIVERSITY HEALTH CENTER INC.
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 502 E GENERAL STEWART WAY STE A
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City | HINESVILLE
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State | GA
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Zip | 31313-2643
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Country | US
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Telephone | 912-318-3947
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Fax | 912-877-0189
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Provider Business Mailing Address
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Address Line | PO BOX 1520
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City | HINESVILLE
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State | GA
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Zip | 31310-8520
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Country | US
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Telephone | 912-318-3947
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. STEPHANIE JONES-THEAKER
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Credential |
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Telephone | 912-318-3947
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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 | 20843
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License Number State | GA
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