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.

Practice address

1309 Ocilla Rd
Suite a
Douglas, GA 31533

Phone

(912) 384-2252

Fax

(912) 384-8888

NPI assigned

Oct 24, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert B Tucker Jr.

Title

Ceo

Phone

(229) 468-9166

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DOUGLAS FAMILY HEALTH Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Federally qualified health center certification: CCN 111858

Legal name

SOUTH CENTRAL PRIMARY CARE CENTER, INC

Doing business as

SOUTH CENTRAL PRIMARY CARE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Nov 18, 1998

Last certification

Nov 18, 1998

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

Jun 19, 1992 in GA

Enrollment address

303 Shirley Ave
Ste B
Douglas, GA 31533-2373

Related CCNs

111829

Other NPIs on the same Medicare enrollment 1

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

• South Central Primary Care Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Douglas, GA
  • NPI 1063840296

  O20070629000611

  Same enrollment

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Leigh Hendley, FNP-C

  • Family Nurse Practitioner
  • Nashville, GA
  • NPI 1437795572

  Corporate Officer

  CMS ownership

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1831273028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E 4TH ST",
            "city": "OCILLA",
            "state": "GA",
            "postal_code": "317741539",
            "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": "1309 OCILLA RD",
            "address_2": "SUITE A",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "31533",
            "telephone_number": "912-384-2252",
            "fax_number": "912-384-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL PRIMARY CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-468-9166",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000611663D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DOUGLAS FAMILY HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert Lynwood Smith, M.D.
• Teresa Smith, PHARMD
• South Central Primary Care Center, Inc
• South Central Primary Care Center, Inc
• South Central Primary Care Center, Inc
• South Georgia Cosmetic & General Dentistry
• South Georgia Eye Partners PC
• South Georgia Therapy Center
• Southcare of Douglas, Inc
• Southeast Lung & Critical Care Specialists

• Federally Qualified Health Center (FQHC) in Douglas, GA
• Providers in Douglas, 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 Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.