Provider Demographics
NPI:1053822742
Name:MIDDLE GEORGIA HEALTH CARE
Entity Type:Organization
Organization Name:MIDDLE GEORGIA HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG-PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-395-6949
Mailing Address - Street 1:610 HARDEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-3438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 HARDEMAN AVE
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-3438
Practice Address - Country:US
Practice Address - Phone:229-395-6949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No177F00000XOther Service ProvidersLodging
No251F00000XAgenciesHome Infusion