Organization
PRIMARY CARE OF SOUTHWEST GEORGIA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN JAMES (CFO)
(229) 723-2660
Entity
Organization
Contact information
Practice address
916 S BROAD ST, UNIT B-2, THOMASVILLE, GA 31792-6113
(229) 226-8800
(229) 226-2036
Mailing address
PO BOX 1479, THOMASVILLE, GA 31799-1479
(229) 226-8800
(229) 226-2036
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003155529A
—
GA
Enumeration date
12/04/2014
Last updated
04/06/2015
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