NPIMap

Organization Active NPI

East Georgia Healthcare Center, Inc.

Doing business as Swainsboro Elementary School

  • Federally Qualified Health Center (FQHC)
  • Swainsboro, GA
National Provider Identifier
1194569228
Registry record updated May 14, 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
Swainsboro Elementary School
Practice address
258 Tiger TRL
Swainsboro, GA 30401-4850
Phone
(478) 237-2638
Fax
(478) 237-9138
NPI assigned
Jun 24, 2024
Last updated
May 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 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

258 Tiger TRL
Swainsboro, GA 30401-4850

Mailing address

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

Other names 1

  • Swainsboro Elementary School Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050722000569 GA Part B Supplier - Clinic/Group Practice 0547228686 Receives reassigned benefits from 49 practitioners
15 other NPIs on this enrollment
Practice locations: Wadley, GA; Vidalia, GA; Sylvania, GA; Swainsboro, GA; Mount Vernon, GA; Stillmore, GA; Statesboro, GA; Soperton, GA…
O20241204000680 GA Part A Provider - Federally Qualified Health Center (FQHC) 0547228686 Practice locations: Swainsboro, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194569228. Details of each certification follow.

Federally qualified health center certification: CCN C21023

Legal name
EAST GEORGIA HEALTHCARE CENTER, INC.
Doing business as
SWAINSBORO ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 27, 2024
Last certification
Aug 27, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1992 in GA
Enrollment address
258 Tiger TRL
Swainsboro, GA 30401-4850

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

Other NPIs on the same Medicare enrollment 15

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

View all 15

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

Ownership & related parties

All disclosed owners & managing parties 16

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 Officer Jan 1, 2021 10%
Gwendolyn Love Individual Corporate DirectorBoard Member Jul 20, 2018
Tabitha Johns Individual Corporate DirectorAccount Manager Oct 1, 2024
Lynda Morgan Individual Corporate DirectorBoard Chairman Jul 20, 2018
Theron D Faison Individual Corporate DirectorBoard Member Jul 20, 2018
Melissa Clifton Individual Corporate DirectorBoard Member Jan 1, 2025
Jennie W Denmark Individual Corporate OfficerCeo Jul 20, 2018
W-2 Managing EmployeeCeo Jul 20, 2018
Elizabeth Hendrix Individual Corporate DirectorBoard Member Jul 20, 2018
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 Officer Mar 1, 2021 10%
Luis Machado Individual Corporate DirectorBoard Member Jul 20, 2018
Amanda R Brown Individual Corporate DirectorBoard Member Jul 20, 2018
Herbert Hodges Individual Corporate DirectorBoard Member Jan 1, 2025
Jill R Sorrells Individual Corporate OfficerCfo Jul 20, 2018
W-2 Managing EmployeeCfo Jul 20, 2018

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.

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1194569228",
    "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": "258 TIGER TRL",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304014850",
            "telephone_number": "478-237-2638",
            "fax_number": "478-237-9138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GEORGIA HEALTHCARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-24",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "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": "Swainsboro Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Swainsboro, GA

Sources for this page

Verify at the official NPI Registry.