Provider Demographics
NPI:1831287655
Name:THE MEDICAL CENTER OF CENTRAL GEORGIA INC.
Entity Type:Organization
Organization Name:THE MEDICAL CENTER OF CENTRAL GEORGIA INC.
Other - Org Name:CENTRAL GEORGIA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHREWSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-633-1452
Mailing Address - Street 1:618 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2081
Mailing Address - Country:US
Mailing Address - Phone:478-633-5600
Mailing Address - Fax:478-784-8753
Practice Address - Street 1:618 ORANGE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2081
Practice Address - Country:US
Practice Address - Phone:478-633-5600
Practice Address - Fax:478-784-8753
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL CENTER OF CENTRAL GEORGIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-169251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000697232AMedicaid
GA00697232AMedicaid