Provider Demographics
NPI:1629254008
Name:THE GOOD SAMARITAN HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:THE GOOD SAMARITAN HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHESTER
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:404-523-6571
Mailing Address - Street 1:1015 DONALD LEE HOLLOWELL PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-6653
Mailing Address - Country:US
Mailing Address - Phone:404-523-6571
Mailing Address - Fax:404-523-6574
Practice Address - Street 1:1015 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-6653
Practice Address - Country:US
Practice Address - Phone:404-523-6571
Practice Address - Fax:404-523-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000915769AMedicaid
GA085002146GMedicaid
GA000282521DMedicaid
GA2238592338BMedicaid
GA000249763EMedicaid
GA00635984BMedicaid
GA000915769AMedicaid
GAD42285Medicare UPIN