Organization
EAST GEORGIA HEALTHCARE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL R SORRELLS (CFO)
(478) 237-6262
Entity
Organization
Contact information
Practice address
118 ALICE COLEMAN DR, VIDALIA, GA 30474-8860
(912) 537-6565
(912) 537-6161
Mailing address
215 N COLEMAN ST, SWAINSBORO, GA 30401-3530
(478) 237-6262
(478) 237-9138
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000632376L
—
GA
Enumeration date
02/11/2009
Last updated
08/26/2015
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