Provider Demographics
NPI:1336332857
Name:FIRST CHOICE PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:FIRST CHOICE PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:MSPH
Authorized Official - Phone:478-787-4266
Mailing Address - Street 1:PO BOX 4363
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4363
Mailing Address - Country:US
Mailing Address - Phone:478-787-4266
Mailing Address - Fax:478-787-4199
Practice Address - Street 1:770 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7307
Practice Address - Country:US
Practice Address - Phone:478-787-4266
Practice Address - Fax:478-787-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA713878795AMedicaid