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
213 N MCDONALD ST STE A&B, LUDOWICI, GA 31316
(912) 545-9398
(912) 545-2747
Mailing address
P.O. BOX 1520, HINESVILLE, GA 31310
(912) 545-9398
(912) 545-2747
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023448459A
—
GA
Enumeration date
12/14/2007
Last updated
06/12/2018
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