EAST GEORGIA HEALTHCARE CENTER INC NPI 1700820917

NPI Information

NPI: 1700820917
Provider Name: EAST GEORGIA HEALTHCARE CENTER INC
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
4357 E LOUISIANA AVE
SOPERTON, GA
ZIP 30457
Phone: (478) 488-4234
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EAST GEORGIA HEALTHCARE CENTER INC is a federally qualified health center (fqhc) clinic center in Soperton, GA. EAST GEORGIA HEALTHCARE CENTER INC NPI is 1700820917. The provider is registered as an organization entity type.

The provider's business location address is:

4357 E LOUISIANA AVE
SOPERTON, GA
ZIP 30457-661
Phone: (478) 488-4234
Fax: (478) 237-9138

The provider's authorized official is Jill R Sorrells .
The authorized official title is Cfo and has the following contact phone number (478) 419-1641.

The enumeration date for this NPI number is 6/16/2006 and was last updated on 5/1/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000632376G	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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