South Central Primary Care Center, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SOUTH CENTRAL PRIMARY CARE CENTER, INC

Doing business as

Valdosta Internal Medicine

Practice address

3308 Greystone Way
Valdosta, GA 31605-1096

Phone

(229) 468-9166

Fax

(229) 468-9188

NPI assigned

Oct 29, 2021

Last updated

Nov 26, 2024By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• VALDOSTA INTERNAL MEDICINE Doing business as

Locations

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1376207985",
    "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": "3308 GREYSTONE WAY",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316051096",
            "telephone_number": "229-468-9166",
            "fax_number": "229-468-9188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL PRIMARY CARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-29",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "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": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VALDOSTA INTERNAL MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VALDOSTA INTERNAL MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• South Georgia Anesthesia Specialists LLC
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• Federally Qualified Health Center (FQHC) in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Federally Qualified Health Center (FQHC) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.