Provider Demographics
NPI:1538117932
Name:BOWDON- MT. ZION PRIMARY HEALTH CENTER ,INC.
Entity Type:Organization
Organization Name:BOWDON- MT. ZION PRIMARY HEALTH CENTER ,INC.
Other - Org Name:CARROLL COUNTY PRIMARY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TONEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:770-836-0103
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:MOUNT ZION
Mailing Address - State:GA
Mailing Address - Zip Code:30150-0658
Mailing Address - Country:US
Mailing Address - Phone:770-836-0103
Mailing Address - Fax:770-834-8828
Practice Address - Street 1:4248 MT. ZION RD
Practice Address - Street 2:
Practice Address - City:MT ZION
Practice Address - State:GA
Practice Address - Zip Code:30150
Practice Address - Country:US
Practice Address - Phone:770-836-0103
Practice Address - Fax:770-834-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000228588AMedicaid
113825Medicare ID - Type Unspecified