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Primary Care of Southwest Georgia, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Thomasville, GA

NPI 1952196560 · NPPES record last updated Apr 21, 2025

Key facts

NPI
1952196560
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
PRIMARY CARE OF SOUTHWEST GEORGIA, INC
Practice address
520 Fletcher St
Thomasville, GA 31792-6438
Phone
(229) 236-6024
Fax
(229) 227-3411
NPI assigned
Apr 14, 2025
Organization subpart
Yes
Parent organization (as reported)
PRIMARY CARE OF SOUTHWEST GEORGIA, INC

Authorized official

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 7

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 7

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

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

Laboratory certificates & supplier records

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

CLIA laboratory certificates

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in GA

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
Corporation · Non-profit
Enrollment address
520 Fletcher St
Thomasville, GA 31792-6438

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 Control
Board Member		 Dec 15, 2020
Wayne Lawson
Individual 		Operational/Managerial Control
Board Member		 Jul 1, 2007
Jennifer Vanderbeek
Individual 		Operational/Managerial Control
Board Member		 Sep 1, 2024
Kenneth Cody
Individual 		Operational/Managerial Control
Board Member		 Jan 1, 2014
Virginia Grist
Individual 		Operational/Managerial Control
Board Member		 Aug 20, 2024
Janis Barron
Individual 		Operational/Managerial Control
Board Member		 Mar 1, 2006
Joan S Simpson
Individual 		Operational/Managerial Control
Board Member		 Jan 1, 2011
Crycynthia Gardner
Individual 		Operational/Managerial Control
Board Member		 Aug 20, 2019
Anthony Yarbrough
Individual 		Operational/Managerial Control
Board Member		 Sep 1, 2024
Dan Provence
Individual 		Operational/Managerial Control
Board Member		 May 12, 2015
Edwin James
Individual 		Corporate Director
Cfo		 Nov 14, 2006
W-2 Managing Employee Nov 14, 2006
Ginger Cushing
Individual 		Corporate Director
Ceo		 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 - TCMS
Thomasville, GA · CCN 111072		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 18, 2017

Medicare enrollment records

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

National Provider Directory

Tax ID family
Primary Care of Southwest Georgia Inc (8 organizations share this tax ID)
Part of
Primary Care of Southwest Georgia Inc

Locations

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

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

Specialties & licenses

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

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

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 21, 2025.

{
    "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

All providers in Thomasville, GA · Federally Qualified Health Center (FQHC) in Georgia

Sources for this page

Verify at the official NPI Registry.