Organization Name: | EAST GEORGIA HEALTHCARE CENTER, INC. |
NPI Number: | 1477738417 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIE WREN C DENMARK (CEO) |
Mailing Address: | 125b Victory Dr Swainsboro |
State: | GA US |
Postal Code: | 304013234 |
Phone Number: | 4782375850 |
Fax Number: | 4782375855 |
NPI Enumeration Date: | 01/09/2008 |
NPI Last Update Date: | 01/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
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: |