Organization Name: | SOUTHWEST GEORGIA HEALTH CARE INC |
NPI Number: | 1063436624 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LINDA J. YOUNG (SECRETARY) |
Mailing Address: | 220 Alston St Richland |
State: | GA US |
Postal Code: | 318251404 |
Phone Number: | 2298873324 |
Fax Number: | 2298873919 |
NPI Enumeration Date: | 07/27/2006 |
NPI Last Update Date: | 01/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | 09/21/2006 |
NPI Reactivation Date: | 05/22/2007 |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |