Provider Demographics
NPI:1750339511
Name:BOWDON- MT. ZION PRIMARY HEALTH CENTER ,INC.
Entity type:Organization
Organization Name:BOWDON- MT. ZION PRIMARY HEALTH CENTER ,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TONEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:770-836-0504
Mailing Address - Street 1:41 WELLINGTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30185-2606
Mailing Address - Country:US
Mailing Address - Phone:770-836-0501
Mailing Address - Fax:770-834-8261
Practice Address - Street 1:41 WELLINGTON MILL RD
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:GA
Practice Address - Zip Code:30185-2606
Practice Address - Country:US
Practice Address - Phone:770-836-0501
Practice Address - Fax:770-834-8261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOWDON MT. ZION PRIMARY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-04
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000254064AMedicaid
GA000254064AMedicaid