Organization
SOUTH CENTRAL PRIMARY CARE CENTER, INC
Active
Other names
KIDS HEALTH FITZGERALD
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BONDS TUCKER (CEO)
(229) 468-9166
Entity
Organization
Contact information
Practice address
299 W BENJAMIN HILL DR, SUITE A, FITZGERALD, GA 31750
(229) 423-5437
Mailing address
204 E 4TH ST, P O BOX 749, OCILLA, GA 31774-1421
(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
—
0003124446A
—
GA
Enumeration date
05/10/2012
Last updated
11/26/2024
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