Provider Demographics
NPI:1407174675
Name:GOOD SAMARITAN HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:GOOD SAMARITAN HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:W
Authorized Official - Last Name:SORRELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-815-0986
Mailing Address - Street 1:175 SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1964
Mailing Address - Country:US
Mailing Address - Phone:706-253-4673
Mailing Address - Fax:706-253-4675
Practice Address - Street 1:175 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1964
Practice Address - Country:US
Practice Address - Phone:706-253-4673
Practice Address - Fax:706-253-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center