Provider Demographics
NPI:1790223352
Name:PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Entity Type:Organization
Organization Name:PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Other - Org Name:PRIMARY CARE OF SOUTHWEST GEORGIA- QUITMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-723-2660
Mailing Address - Street 1:360 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-2554
Mailing Address - Country:US
Mailing Address - Phone:229-723-2660
Mailing Address - Fax:229-723-5962
Practice Address - Street 1:907 N COURT ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-1315
Practice Address - Country:US
Practice Address - Phone:229-263-4531
Practice Address - Fax:229-263-5787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)