Provider Demographics
NPI:1265274120
Name:DIVERSITY HEALTH CENTER INC.
Entity type:Organization
Organization Name:DIVERSITY HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES-HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-318-3947
Mailing Address - Street 1:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31310-8520
Mailing Address - Country:US
Mailing Address - Phone:912-545-9398
Mailing Address - Fax:912-545-2047
Practice Address - Street 1:213 N MCDONALD ST STE D
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-6075
Practice Address - Country:US
Practice Address - Phone:912-545-9398
Practice Address - Fax:912-545-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE011178OtherPHARMACY PERMIT