Organization
SOUTH CENTRAL PRIMARY CARE CENTER, INC
Active
Other names
SOUTH CENTRAL FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT B TUCKER JR. (CFO)
(229) 468-9166
Entity
Organization
Contact information
Practice address
640 MAIN ST N, PEARSON, GA 31642
(912) 544-4569
(912) 422-3180
Mailing address
204 E 4TH ST, OCILLA, GA 31774-1539
(229) 468-9166
(229) 468-9188
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000611663F
—
GA
Enumeration date
10/24/2006
Last updated
11/26/2024
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