NPIMap

Organization Active NPI

East Georgia Healthcare Center, Inc.

Doing business as Langston Chapel Schools

  • Federally Qualified Health Center (FQHC)
  • Statesboro, GA
National Provider Identifier
1063373264
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST GEORGIA HEALTHCARE CENTER, INC.
Doing business as
Langston Chapel Schools
Practice address
150 Langston Chapel Rd
Statesboro, GA 30458-3412
Phone
(478) 494-9926
Fax
(478) 237-9138
NPI assigned
Nov 19, 2025
Last updated
Nov 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jill R Sorrells
Title
Cfo
Phone
(478) 237-6262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

150 Langston Chapel Rd
Statesboro, GA 30458-3412

Mailing address

215 N Coleman St
Swainsboro, GA 30401-3530
Phone (478) 237-2638

Other names 1

  • Langston Chapel Schools Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251126001629 GA Part A Provider - Federally Qualified Health Center (FQHC) 0547228686 Practice locations: Statesboro, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063373264. Details of each certification follow.

Federally qualified health center certification: CCN C21048

Legal name
EAST GEORGIA HEALTHCARE CENTER, INC.
Doing business as
LANGSTON CHAPEL SCHOOLS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 26, 2025
Last certification
Nov 26, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
150 Langston Chapel Rd
Statesboro, GA 30458-3412

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2329975East Georgia Healthcare Center at Langston Chapel150 Langston Chapel Road, Statesboro, GA 30458Certificate of waiverSep 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Ga Hlthcare Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

150 Langston Chapel Rd
Statesboro, GA 30458
Phone (478) 494-9926

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joel Salgado Individual Corporate DirectorBoard Member Jan 1, 2021
Gwendolyn Love Individual Corporate DirectorBoard Member Jul 20, 2018
Tabitha Johns Individual Corporate DirectorAccounting Director Oct 1, 2024
Lynda Morgan Individual Corporate DirectorBoard Member Jul 20, 2018
Melissa Clifton Individual Corporate DirectorBoard Member Jan 1, 2025
Jennie W Denmark Individual Corporate OfficerCeo Jan 30, 2007
W-2 Managing EmployeeCeo Jan 30, 2007
Elizabeth Hendrix Individual Corporate DirectorBoard Member Nov 17, 1999
Kenneth Griffin Individual Corporate DirectorBoard Member Jan 1, 2025
Barbara Bruno Individual Corporate DirectorBoard Member Jan 1, 2025
Lynne Hillis Individual Corporate DirectorBoard Member Jan 1, 2025
Ken Mercer Individual Corporate DirectorBoard Member Jul 2, 2018
Luis Machado Individual Corporate DirectorBoard Member Jul 20, 2018
Amanda R Brown Individual Corporate DirectorBoard Member Mar 1, 2009
Herbert Hodges Individual Corporate DirectorBoard Member Jan 1, 2025
Jill R Sorrells Individual Corporate OfficerCfo Jul 2, 2005
W-2 Managing EmployeeCfo Jul 1, 2005

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Statesboro Pediatrics and Family Healthcare CenterStatesboro, GA, CCN 111931 Federally qualified health center Other Mar 12, 2013
East Georgia Healthcare Center, Inc.Baxley, GA, CCN 111977 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2014
East Georgia Healthcare Center, Inc.Millen, GA, CCN 111063 Federally qualified health center Operational/Managerial Control May 1, 2017

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763510400000",
    "number": "1063373264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N COLEMAN ST",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013530",
            "telephone_number": "478-237-2638",
            "fax_number": "478-237-9138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 LANGSTON CHAPEL RD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304583412",
            "telephone_number": "478-494-9926",
            "fax_number": "478-237-9138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GEORGIA HEALTHCARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-19",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A",
        "authorized_official_last_name": "SORRELLS",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "478-237-6262"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Langston Chapel Schools",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesboro, GA

Sources for this page

Verify at the official NPI Registry.