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General NPI Number Information
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NPI Number | 1790924918
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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 | 02/11/2009
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 118 ALICE COLEMAN DR
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City | VIDALIA
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State | GA
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Zip | 30474-8860
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Country | US
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Telephone | 912-537-6565
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Fax | 912-537-6161
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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 | 478-237-6262
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Fax | 478-237-9138
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Authorized Official
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Title or Position | CFO
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Name | JILL R SORRELLS
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Credential |
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Telephone | 478-237-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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