R T Stanley Health Center LLC
Organization Active NPI Rural Health Clinic/Center · Lyons, GA
NPI 1790778736 · NPPES record last updated Aug 27, 2019
Key facts
- NPI
- 1790778736
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 138-476 (GA)
- Legal business name
- R T STANLEY HEALTH CENTER LLC
- Practice address
- 110 RT Stanley Sr PL
Lyons, GA 30436-5623 - Phone
- (912) 526-9355
- Fax
- (912) 526-8622
- NPI assigned
- Aug 24, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- SOUTHEAST REGIONAL PRIMARY CARE CORP
Authorized official
- Name
- Tony M Osteen
- Title
- Cfo
- Phone
- (912) 535-8691
Practitioners 4
-
Christopher Cullen Scott, M.D.
-
Kristin Brantley, NP
-
Catherine W Reavis, FNP
National Provider Directory
- Part of
- Southeast Regional Primary Care Corporation
Locations
110 Rt Stanley SR Pl
Lyons, GA 30436
Phone (912) 526-9355
110 S State St
#R
Lyons, GA 30436
Phone (912) 526-9355
Interoperability endpoints
- thomas.ferrari@rts.gadirect.net
- christina.dacey@rts.gadirect.net
- james.cornwell@rts.gadirect.net
- candice.barfield@rts.gadirect.net
- gary.laubacker@rts.gadirect.net
- christopher.scott@rts.gadirect.net
- kathleen.bridges@rts.gadirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 138-476 | GA | Yes |
Addresses
Primary practice location
110 RT Stanley Sr PL
Lyons, GA 30436-5623
Mailing address
PO Box 407
Vidalia, GA 30475-0407
Phone (912) 537-4986
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11-8904 | Other | GA | MEDICARE ID-TYPE UNSPECIFIED |
| 0003111970A | Medicaid | GA |
Other names
- R T STANLEY HEALTH CENTER LLC
Other providers in Lyons, GA
- Medivan Transport, LLC
- Jay Mosley
- Ben B Neely
- Nurses Plus II, Inc.
- Quality Health Services, Inc.
- Catherine W Reavis
- Redirection Inc
- Brian Rickard
- Brandy W Sikes
- Smiles P.C.
All providers in Lyons, GA · Rural Health Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.