NPIMap

Organization Active NPI

Primary Care of Southwest Georgia, Inc

Doing business as Primary Care of Southwest Georgia, Inc - HES

  • Federally Qualified Health Center (FQHC)
  • Thomasville, GA
National Provider Identifier
1952196560
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE OF SOUTHWEST GEORGIA, INC
Doing business as
Primary Care of Southwest Georgia, Inc - HES
Practice address
520 Fletcher St
Thomasville, GA 31792-6438
Phone
(229) 236-6024
Fax
(229) 227-3411
NPI assigned
Apr 14, 2025
Last updated
Apr 21, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMARY CARE OF SOUTHWEST GEORGIA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Authorized official

Name
Edwin James
Title
Cfo
Phone
(229) 723-2660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

520 Fletcher St
Thomasville, GA 31792-6438

Mailing address

360 College St
Blakely, GA 39823-2554
Phone (229) 723-2660

Other names 1

  • Primary Care of Southwest Georgia, Inc - HES Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060201000362 GA Part B Supplier - Clinic/Group Practice 5496777948 Receives reassigned benefits from 22 practitioners
7 other NPIs on this enrollment
Practice locations: Bainbridge, GA; Thomasville, GA; Quitman, GA; Blakely, GA
O20250506001860 GA Part A Provider - Federally Qualified Health Center (FQHC) 5496777948 Practice locations: Thomasville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952196560. Details of each certification follow.

Federally qualified health center certification: CCN C21044

Legal name
PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Doing business as
PRIMARY CARE OF SOUTHWEST GEORGIA, INC. - HES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 10, 2025
Last certification
Sep 10, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
520 Fletcher St
Thomasville, GA 31792-6438

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2322521Primary Care of Southwest Georgia, Inc - Hes520 Fletcher Street, Thomasville, GA 31792Certificate of waiverApr 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Primary Care of SW Ga Inc8 organizations share this tax ID, including this one
Part of
Primary Care of SW Ga Inc

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

283 Martin Luther King Jr Blvd
Blakely, GA 39823
Phone (229) 366-0688

3053 N Church St
Meigs, GA 31765
Phone (229) 683-3406

4681 US Highway 84 Byp W
Thomasville, GA 31792
Phone (229) 227-2936

520 Fletcher St
Thomasville, GA 31792
Phone (229) 236-6024

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Natalie Singletary Individual Operational/Managerial ControlBoard Member Dec 15, 2020
Wayne Lawson Individual Operational/Managerial ControlBoard Member Jul 1, 2007
Jennifer Vanderbeek Individual Operational/Managerial ControlBoard Member Sep 1, 2024
Kenneth Cody Individual Operational/Managerial ControlBoard Member Jan 1, 2014
Virginia Grist Individual Operational/Managerial ControlBoard Member Aug 20, 2024
Janis Barron Individual Operational/Managerial ControlBoard Member Mar 1, 2006
Joan S Simpson Individual Operational/Managerial ControlBoard Member Jan 1, 2011
Crycynthia Gardner Individual Operational/Managerial ControlBoard Member Aug 20, 2019
Anthony Yarbrough Individual Operational/Managerial ControlBoard Member Sep 1, 2024
Dan Provence Individual Operational/Managerial ControlBoard Member May 12, 2015
Edwin James Individual Corporate DirectorCfo Nov 14, 2006
W-2 Managing Employee Nov 14, 2006
Ginger Cushing Individual Corporate DirectorCeo Mar 18, 2024
W-2 Managing Employee Mar 18, 2024

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Primary Care of Southwest Georgia, Inc.Quitman, GA, CCN 111060 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 23, 2017
Primary Care of Southwest Georgia - TCMSThomasville, GA, CCN 111072 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 18, 2017

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 40

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.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1744588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745193600000",
    "number": "1952196560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 COLLEGE ST",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232554",
            "telephone_number": "229-723-2660",
            "fax_number": "229-723-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 FLETCHER ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926438",
            "telephone_number": "229-236-6024",
            "fax_number": "229-227-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF SOUTHWEST GEORGIA, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE OF SOUTHWEST GEORGIA, INC",
        "enumeration_date": "2025-04-14",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-723-2660"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care of Southwest Georgia, Inc - HES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Primary Care of Southwest Georgia, Inc - HES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thomasville, GA

Sources for this page

Verify at the official NPI Registry.