NPIMap

Organization Active NPI

South Central Primary Care Center, Inc

  • Pharmacy
  • Valdosta, GA
National Provider Identifier
1114755931
Registry record updated Mar 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
SOUTH CENTRAL PRIMARY CARE CENTER, INC
Practice address
2301 N Ashley St
Valdosta, GA 31602-2620
Phone
(229) 270-2403
NPI assigned
Jul 23, 2024
Last updated
Mar 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2025

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

Authorized official

Name
Robert Bonds Tucker
Title
Ceo
Phone
(229) 468-9166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

2301 N Ashley St
Valdosta, GA 31602-2620

Mailing address

PO Box 749
Ocilla, GA 31774-0749
Phone (229) 468-9166

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240229001353 GA Part B Supplier - Pharmacy 1951395920 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Valdosta, GA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
South Central Primary C14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743379200000",
    "number": "1114755931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749",
            "city": "OCILLA",
            "state": "GA",
            "postal_code": "317740749",
            "telephone_number": "229-468-9166",
            "fax_number": "229-468-9188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 N ASHLEY ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022620",
            "telephone_number": "229-270-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL PRIMARY CARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-23",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-31",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "BONDS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-468-9166"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.