Organization
PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN V JAMES BBA MBA (CHIEF FINANCIAL OFFICER)
(229) 723-2660
Entity
Organization
Contact information
Practice address
360 COLLEGE STREET, BLAKELY, GA 39823
(229) 723-2660
(229) 723-2663
Mailing address
360 COLLEGE STREET, BLAKELY, GA 39823
(229) 723-2660
(229) 723-2663
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
060068
GA
207R00000X
Internal Medicine Physician
057747
GA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LF0000X
Family Nurse Practitioner
RN188412
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024893266A
—
GA
Enumeration date
07/25/2006
Last updated
05/15/2014
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