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General NPI Number Information
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NPI Number | 1962467217
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Entity Type | Organization
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Legal Business Name | SOUTHWEST GEORGIA HEALTHCARE CLINICS, INC
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 900 N WILEY AVE
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City | DONALSONVILLE
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State | GA
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Zip | 39845-1127
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Country | US
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Telephone | 229-524-8489
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Fax | 229-524-6237
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Provider Business Mailing Address
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Address Line | 900 N WILEY AVE
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City | DONALSONVILLE
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State | GA
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Zip | 39845-1127
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Country | US
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Telephone | 229-524-8489
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Fax | 229-524-6237
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Authorized Official
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Title or Position | CFO
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Name | JAMES MOODY
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Credential |
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Telephone | 229-524-5217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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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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