Organization
MCKINNEY COMMUNITY HEALTH CTR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. OLA SMITH (CEO)
(912) 287-0301
Entity
Organization
Contact information
Practice address
623 SYCAMORE ST, BLACKSHEAR, GA 31516-2119
(912) 449-3294
(912) 287-1568
Mailing address
218 QUARTERMAN ST, WAYCROSS, GA 31501-3547
(912) 287-0301
(912) 287-1568
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000715415C
—
GA
01
—
10066125
AMERIGROUP
GA
01
—
336245
WELLCARE
GA
Enumeration date
06/24/2008
Last updated
10/29/2008
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