Organization
SOUTH CENTRAL PRIMARY CARE CENTER, INC
Active
Other names
KIDS HEALTH, SOUTH CENTRAL PRIMARY CARE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT B TUCKER JR. CEO (CEO)
(229) 468-9166
Entity
Organization
Contact information
Practice address
303 SHIRLEY AVE, STE B, DOUGLAS, GA 31533
(912) 384-2474
(912) 384-4995
Mailing address
204 E 4TH ST, P O BOX 749, OCILLA, GA 31774-1539
(229) 468-9166
(229) 468-9188
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140047A
—
GA
Enumeration date
10/25/2013
Last updated
04/03/2025
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