Diversity Health Center Inc.
Organization Active NPI Community/Retail Pharmacy · Jesup, GA
NPI 1770107286 · NPPES record last updated Jun 1, 2020
Key facts
- NPI
- 1770107286
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- DIVERSITY HEALTH CENTER INC.
- Practice address
- 244 Peachtree St
Jesup, GA 31545-0212 - Phone
- (912) 385-2453
- Fax
- (912) 559-2083
- NPI assigned
- Jun 1, 2020
- Organization subpart
- No
Authorized official
- Name
- Mrs. Stephanie Jones-Heath
- Title
- Ceo
- Phone
- (912) 318-3947
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 7
Practitioners 12
-
Joshua Brooks Allen, FNP
-
Seth A Borquaye, M.D.
-
Nakia S Ealy, APRN
-
Tomeka Lashun Evans, FNP-C
-
Jeanine Nicole Frazier, ARNP
-
Crystal Malloy, PHD, LPC, MAC, CEAP
-
Shanekia Marsh, NP-C
-
Natalia T Rodriguez, FNP
-
Aiyesha Quante Stiles, APRN
-
Princess Fonseca, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200615001490 | GA | Part B Supplier - Pharmacy | 9638261910 | Practice locations: Jesup, GA |
National Provider Directory
- Tax ID family
- Diversity Health Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
244 Peachtree St
Jesup, GA 31545-0212
Mailing address
PO Box 1520
Hinesville, GA 31310-8520
Phone (912) 545-9398
Other providers in Jesup, GA
- Kyle Steven Deuter
- Diabetes Center of Jesup LLC
- Michael Jeffrey Wildenberg Diamant
- Robert Stuart Diamant
- Diversity Health Center Inc.
- Mackenzie Taylor Dixon
- Stephanie Rogers Doane
- Donald F Kennedy Jr MD PC
- Tabitha Lynn Douglas
- Dr. Eddie D. Thomas, M.D.,P.C.
All providers in Jesup, GA · Community/Retail Pharmacy in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.