Organization
EAST GEORGIA HEALTHCARE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIE WREN DENMARK (CEO)
(478) 237-2638
Entity
Organization
Contact information
Practice address
117 MEMORIAL DR, REIDSVILLE, GA 30453-4641
(912) 557-3300
(912) 557-3328
Mailing address
215 N COLEMAN ST, SWAINSBORO, GA 30401-3530
(478) 237-2638
(478) 237-9138
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000632376F
—
GA
01
—
111887
MEDICARE PROVIDER NUMBER
—
Enumeration date
06/06/2006
Last updated
07/31/2015
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