EAST GEORGIA HEALTHCARE CENTER INC. NPI 1790924918

NPI Information

NPI: 1790924918
Provider Name: EAST GEORGIA HEALTHCARE CENTER, INC.
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 11D1100386

Address:
118 ALICE COLEMAN DR
VIDALIA, GA
ZIP 30474
Phone: (912) 537-6565
Get Directions

EAST GEORGIA HEALTHCARE CENTER, INC. is a federally qualified health center (fqhc) clinic center in Vidalia, GA. EAST GEORGIA HEALTHCARE CENTER, INC. NPI is 1790924918. The provider is registered as an organization entity type.

The provider's business location address is:

118 ALICE COLEMAN DR
VIDALIA, GA
ZIP 30474-860
Phone: (912) 537-6565
Fax: (912) 537-6161

The provider's authorized official is Jill R Sorrells .
The authorized official title is Cfo and has the following contact phone number (478) 237-6262.

The CLIA number assigned to this NPI record is 11D1100386 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/11/2009 and was last updated on 8/26/2015.

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	261QD0000X	Clinic/Center	Dental			No
2	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	000632376L	MEDICAID	GEORGIA
2	111921	MEDICARE OSCAR/CERTIFICATION

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: 4/28/2024

NPI Synchronization or Removal

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