NPIMap

Organization Active NPI

Southwest Georgia Healthcare Clinics Inc

  • Federally Qualified Health Center (FQHC)
  • Donalsonville, GA
National Provider Identifier
1881867000
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHWEST GEORGIA HEALTHCARE CLINICS INC
Doing business as
Southwest Georgia Healthcare Clinics,Inc
Practice address
205 Bresee Street
Donalsonville, GA 39845
Phone
(229) 524-1307
Fax
(229) 524-6268
NPI assigned
Apr 9, 2008
Last updated
Aug 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHWEST GEORGIA HEALTHCARE CLINICS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Authorized official

Name
Donna L Williams, CEO
Title
Ceo
Phone
(229) 524-1307

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Multi-Specialty Clinic/Center 261QM1300X
Pediatrics Physician 208000000X

Addresses

Primary practice location

205 Bresee Street
Donalsonville, GA 39845

Mailing address

205 Bresee Street
Donalsonville, GA 39845
Phone (229) 524-1307

Other names 2

  • Southwest Georgia Healthcare Clinics,Inc Doing business as
  • Southwest Georgia Healthcare Clinics Pediatrics Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170613002024 GA Part B Supplier - Clinic/Group Practice 9739457896 Receives reassigned benefits from 8 practitioners
3 other NPIs on this enrollment
Practice locations: Donalsonville, GA
O20190131003388 GA Part A Provider - Federally Qualified Health Center (FQHC) 9739457896 Practice locations: Donalsonville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881867000. Details of each certification follow.

Federally qualified health center certification: CCN 111105

Legal name
SOUTHWEST GEORGIA HEALTHCARE CLINICS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 21, 2018
Last certification
Dec 21, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 3, 2015 in GA
Enrollment address
205 Bresee St
Donalsonville, GA 39845-1134

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Southwest Georgia Healthcare Clinics Inc

Locations

205 Bresee St
Donalsonville, GA 39845
Phone (229) 524-1307

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Kemberly Earnest Individual Corporate DirectorBoard Member/ Treasurer Nov 1, 2018
Betty Orange Individual Corporate DirectorBoard Member/ Secretary Nov 1, 2018
Brenda Peterson Individual Corporate DirectorBoard Member Nov 1, 2018
Katie Hatcher Individual Contracted Managing EmployeeCfo Oct 1, 2022
William Burke Individual Corporate DirectorBoard Member/Chairman Nov 1, 2018
Donna L Williams Individual Corporate OfficerCeo Nov 1, 2018 100%
Herman Brookins Individual Corporate DirectorBoard Member Nov 1, 2018
Newton King Individual Corporate DirectorBoard Member Nov 1, 2018
Charles H Orrick Individual Corporate DirectorBoard Member Nov 1, 2018

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southwest Georgia Healthcare Clinics, Inc.Donalsonville, GA, CCN 111187 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Southwest Georgia Healthcare Clinics, Inc.Donalsonville, GA, CCN 111803 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691107200000",
    "number": "1881867000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 BRESEE STREET",
            "city": "DONALSONVILLE",
            "state": "GA",
            "postal_code": "39845",
            "telephone_number": "229-524-1307",
            "fax_number": "229-524-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 BRESEE STREET",
            "city": "DONALSONVILLE",
            "state": "GA",
            "postal_code": "39845",
            "telephone_number": "229-524-1307",
            "fax_number": "229-524-6268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST GEORGIA HEALTHCARE CLINICS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHWEST GEORGIA HEALTHCARE CLINICS INC",
        "enumeration_date": "2008-04-09",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-524-1307",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Georgia Healthcare Clinics,Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Georgia Healthcare Clinics Pediatrics",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Southwest Georgia Healthcare Clinics Pediatrics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Donalsonville, GA

Sources for this page

Verify at the official NPI Registry.