Provider Demographics
NPI:1962467217
Name:SOUTHWEST GEORGIA HEALTHCARE CLINICS, INC
Entity Type:Organization
Organization Name:SOUTHWEST GEORGIA HEALTHCARE CLINICS, INC
Other - Org Name:SOUTHWEST GEORGIA HEALTHCARE CLINICS WOMEN'S CTN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-524-5217
Mailing Address - Street 1:900 N WILEY AVE
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-1127
Mailing Address - Country:US
Mailing Address - Phone:229-524-8489
Mailing Address - Fax:229-524-6237
Practice Address - Street 1:900 N WILEY AVE
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1127
Practice Address - Country:US
Practice Address - Phone:229-524-8489
Practice Address - Fax:229-524-6237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST GEORGIA HEALTHCARE CLINICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-19
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty