East Georgia Healthcare Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Swainsboro, GA
NPI 1194569228 · NPPES record last updated May 14, 2025
Key facts
- NPI
- 1194569228
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- EAST GEORGIA HEALTHCARE CENTER, INC.
- Practice address
- 258 Tiger TRL
Swainsboro, GA 30401-4850 - Phone
- (478) 237-2638
- Fax
- (478) 237-9138
- NPI assigned
- Jun 24, 2024
- Organization subpart
- No
Authorized official
- Name
- Jill R Sorrells
- Title
- Cfo
- Phone
- (478) 237-6262
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 15
Other NPIs with the same Medicare PAC ID 16
Corporate family (same tax ID) 19
Practitioners 49
-
Michael Austin, M.D.
-
Joseph Chad Clifton, L.C.S.W.
-
Sreevalli Dega, MD
-
Mark Allen Haddock, D.C.
-
Tekisha Jones, FNP
-
Beverly Knighten, LCSW
-
Patrick M Riner, O.D.
-
Martin R Sheldon, MD
-
Phyllis Evon Solomon, FNP
-
Mary L Sparkes, MD
-
Emily Jane Tatum, MD
-
Bob H Barrett, O.D.
-
Jacob Funk, D.C.
-
Pamela Sheldon, LICSW
-
Abhijit Singh, MD
-
Lynn Marie Allmond, FNP-BC
-
Jean M Bailey, NP-C
-
Julie G. Bird, APRN
-
Jamye Bellamy Clark, FNP-C
-
Morgan Royal Comstock, FNP-C
-
Lorene Davis, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
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
- Corporation · Non-profit
- Incorporated
- May 29, 1992 in GA
- Enrollment address
- 258 Tiger TRL
Swainsboro, GA 30401-4850
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Joel Salgado |
Corporate Officer | Jan 1, 2021 | 10% |
| Gwendolyn Love |
Corporate Director |
Jul 20, 2018 | |
| Tabitha Johns |
Corporate Director |
Oct 1, 2024 | |
| Lynda Morgan |
Corporate Director |
Jul 20, 2018 | |
| Theron D Faison |
Corporate Director |
Jul 20, 2018 | |
| Melissa Clifton |
Corporate Director |
Jan 1, 2025 | |
| Jennie W Denmark |
Corporate Officer |
Jul 20, 2018 | |
| W-2 Managing Employee |
Jul 20, 2018 | ||
| Elizabeth Hendrix |
Corporate Director |
Jul 20, 2018 | |
| Kenneth Griffin |
Corporate Director |
Jan 1, 2025 | |
| Barbara Bruno |
Corporate Director |
Jan 1, 2025 | |
| Lynne Hillis |
Corporate Director |
Jan 1, 2025 | |
| Ken Mercer |
Corporate Officer | Mar 1, 2021 | 10% |
| Luis Machado |
Corporate Director |
Jul 20, 2018 | |
| Amanda R Brown |
Corporate Director |
Jul 20, 2018 | |
| Herbert Hodges |
Corporate Director |
Jan 1, 2025 | |
| Jill R Sorrells |
Corporate Officer |
Jul 20, 2018 | |
| W-2 Managing Employee |
Jul 20, 2018 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Statesboro Pediatrics and Family Healthcare Center |
Federally qualified health center | Other | Mar 12, 2013 |
| East Georgia Healthcare Center, Inc. |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 1, 2014 |
| East Georgia Healthcare Center, Inc. |
Federally qualified health center | Operational/Managerial Control | May 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- East Ga Hlthcare Ctr Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
- Swainsboro Elementary School
Other providers in Swainsboro, GA
- Katie Durden
- Berine Denise Early
- East Georgia Healthcare Center Inc
- East Georgia Healthcare Center Inc
- East Georgia Healthcare Center Inc
- East Georgia Healthcare Center, Inc.
- East Georgia Healthcare Center, Inc.
- East Georgia Healthcare Center, Inc.
- East Georgia Healthcare Center, Inc.
- East Georgia Healthcare Center, Inc.
All providers in Swainsboro, GA · Federally Qualified Health Center (FQHC) in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.