Organization
DIVERSITY HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE JONES-THEAKER (CEO)
(912) 318-3947
Entity
Organization
Contact information
Practice address
303 FRASER DR, HINESVILLE, GA 31313
(912) 877-2227
(912) 877-2332
Mailing address
PO BOX 1520, HINESVILLE, GA 31310-8520
(912) 877-2227
(912) 877-2332
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179704037A
—
GA
Enumeration date
03/29/2007
Last updated
06/12/2018
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