Provider Demographics
NPI:1366641318
Name:PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Entity Type:Organization
Organization Name:PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-723-2660
Mailing Address - Street 1:PO BOX 1479
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1479
Mailing Address - Country:US
Mailing Address - Phone:229-227-5510
Mailing Address - Fax:229-227-5527
Practice Address - Street 1:454 SMITH AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5535
Practice Address - Country:US
Practice Address - Phone:229-227-5510
Practice Address - Fax:229-227-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA024893266CMedicaid
GA024893266CMedicaid
GAGRP7568Medicare PIN