| Organization Name: | SOUTH CENTRAL PRIMARY CARE CENTER |
| NPI Number: | 1538390729 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT B TUCKER (CFO) |
| Mailing Address: | 610 N Irwin Ave Ocilla |
| State: | GA US |
| Postal Code: | 317740749 |
| Phone Number: | 2294687762 |
| Fax Number: | 2294689302 |
| NPI Enumeration Date: | 08/05/2009 |
| NPI Last Update Date: | 08/05/2009 |
| 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: | |