Screven County Family Health Center, LLC
Organization Active NPI Rural Health Clinic/Center · Sylvania, GA
NPI 1841432044 · NPPES record last updated Nov 20, 2025
Key facts
- NPI
- 1841432044
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SCREVEN COUNTY FAMILY HEALTH CENTER, LLC
- Practice address
- 105 Rocky Ford Rd
Sylvania, GA 30467-2027 - Phone
- (912) 564-7133
- Fax
- (912) 564-2617
- NPI assigned
- Apr 2, 2009
- Organization subpart
- Yes
- Parent organization (as reported)
- SCREVEN COUNTY FAMILY HEALTH CENTER, LLC
Authorized official
- Name
- Mr. David Alex Villa
- Title
- Ceo
- Phone
- (912) 629-7797
Owners & managing parties with NPI records 3
Related certifications (CCN) 1
Facilities with the same owner 23
Practitioners 46
-
Karen Beale Anderson, FNP
-
Sidney James Morgan, M.D., M.P.H.
-
Jean M Bailey, NP-C
-
Prakul Chandra, MD
-
Curtis Cheeks Jr., M.D.
-
David M Cheney, M.D.
-
Kendall Clark, FNP-C
-
Sandra Davis, PT
-
Catherine K Dickens, M.D.
-
Stuart M Fife, PT
-
Eric G. Fogam, MD
-
Heywood Kyle Gay, MD
-
Jodi Brannen Gilmer, PA-C
-
Fanta Elizabeth Kasiah, M.D.
-
Kevin D Keith, D.O.
-
William Kent, MD
-
Marian Lane, MD
-
Alison A. Lauber, MD
-
John Charles Meholic, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2046215 | Optim Primary Care - Sylvania | Certificate of waiver | May 17, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Rural health clinic certification: CCN 118550
- Legal name
- SCREVEN COUNTY FAMILY HEALTH CENTER LLC
- Doing business as
- OPTIM PRIMARY CARE- SLYVANIA
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 9, 2011
- Last certification
- Mar 30, 2022
- Ownership / control type
- 1B
- Organization structure
- LLC · Proprietary
- Incorporated
- Oct 4, 2010 in GA
- Enrollment address
- 105 Rocky Ford Road
Sylvania, GA 30467-2027 - Related CCNs
- 111312
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Community Hospital Management Company LLC |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| SP Holdco I Inc |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| National Surgical Hospitals, LLC |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| Jennifer B Baldock |
Corporate Officer |
Sep 1, 2017 | |
| Bcpe Seminole Holdings, LP |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 66.4% |
| Surgery Partners Inc |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| Community Hospital Holding Company, LLC |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| Screven County Hospital LLC |
5% Or Greater Direct Ownership Interest | Nov 7, 2011 | 100% |
| Operational/Managerial Control | Sep 1, 2017 | ||
| Surgery Center Holdings Inc |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| David Alex Villa |
Corporate Officer |
Oct 1, 2024 | |
| W-2 Managing Employee |
Oct 1, 2024 | ||
| Bradley R Owens |
Other | Dec 2, 2019 | |
| NSH Georgia Inc |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| Surgery Center Holdings LLC |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090710000290 | GA | Part B Supplier - Clinic/Group Practice | 4981756624 |
Receives reassigned benefits from 2 practitioners 4 other NPIs on this enrollment Practice locations: Sylvania, GA |
| O20141016000417 | GA | Part a Provider - Rural Health Clinic | 4981756624 | Practice locations: Sylvania, GA |
National Provider Directory
- Part of
- Screven Cty Fam HLTH Ctr PC
Locations
594 S Columbia Ave
Ste 100
Rincon, GA 31326
Phone (248) 412-3450
105 Rocky Ford Rd
Sylvania, GA 30467
Phone (912) 564-7133
215 Mims Rd
#209C
Sylvania, GA 30467
Phone (912) 564-5977
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 021262 | GA | |
| Internal Medicine Physician |
207R00000X | |||
| Rural Health Clinic/Center | 261QR1300X | GA | Yes |
Addresses
Primary practice location
105 Rocky Ford Rd
Sylvania, GA 30467-2027
Mailing address
460 Mall Blvd Ste B
Savannah, GA 31406-4891
Phone (912) 644-5300
Other names
- Optim Primary Care - Sylvania
Other providers in Sylvania, GA
- Hollie Desselle Pryor
- Cynthia Laree Roper
- Stephanie Royals
- Alma Sabb
- Screven County Commissioners of Roads & Revenue
- Screven County Family Medicine
- Screven County Health Department
- Screven County Health Department
- Screven County Hospital
- Screven County Hospital LLC
All providers in Sylvania, 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 Nov 20, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.