Organization
MCKINNEY MEDICAL CENTER INC
Active
Parent organization
MCKINNEY MEDICAL CENTER INC
Other names
Mckinney Community Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCKINNEY MEDICAL CENTER INC
Authorized official
OLA SMITH (CEO)
(912) 287-0301
Entity
Organization
Contact information
Practice address
218 QUARTERMAN ST, WAYCROSS, GA 31501
(912) 287-9140
(912) 287-1568
Mailing address
218 QUARTERMAN ST, WAYCROSS, GA 31501
(912) 287-0301
(912) 287-1568
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
GA
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000715415A WAYCROSS
—
GA
01
—
10066125
AMERIGROUP
GA
01
—
336243
WELLCARE
GA
Enumeration date
08/11/2006
Last updated
06/05/2019
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