Provider Demographics
NPI:1881867000
Name:SOUTHWEST GEORGIA HEALTHCARE CLINICS INC
Entity Type:Organization
Organization Name:SOUTHWEST GEORGIA HEALTHCARE CLINICS INC
Other - Org Name:SOUTHWEST GEORGIA HEALTHCARE CLINICS PEDIATRICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:229-524-1307
Mailing Address - Street 1:205 BRESEE STREET
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845
Mailing Address - Country:US
Mailing Address - Phone:229-524-1307
Mailing Address - Fax:229-524-6268
Practice Address - Street 1:205 BRESEE STREET
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845
Practice Address - Country:US
Practice Address - Phone:229-524-1307
Practice Address - Fax:229-524-6268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST GEORGIA HEALTHCARE CLINICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-09
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty