Southwest Georgia Healthcare Clinics, Inc

Key facts

NPI: 1962467217
Entity type: Organization (NPI type 2)
Primary specialty: Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name: SOUTHWEST GEORGIA HEALTHCARE CLINICS, INC
Practice address: 900 N Wiley Ave
Donalsonville, GA 39845-1127
Phone: (229) 524-8489
Fax: (229) 524-6237
NPI assigned: Apr 19, 2006
Organization subpart: Yes
Parent organization (as reported): SOUTHWEST GEORGIA HEALTHCARE CLINICS INC

Authorized official

Name: James Moody
Title: Cfo
Phone: (229) 524-5217

Other NPIs on the same Medicare enrollment 3

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

Southwest Georgia Healthcare Clinics Inc Federally Qualified Health Center (FQHC) · Donalsonville, GA · NPI 1396484606

Same enrollment O20170613002024
Southwest Georgia Healthcare Clinics Inc Federally Qualified Health Center (FQHC) · Donalsonville, GA · NPI 1649918152

Same enrollment O20170613002024
Southwest Georgia Healthcare Clinics Inc Federally Qualified Health Center (FQHC) · Donalsonville, GA · NPI 1881867000

Same enrollment O20170613002024

Practitioners 3

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

Sarah Walker Hampton, MD Internal Medicine Physician · Donalsonville, GA · NPI 1609872217

NPD
Jacob Harvey Holley III, M.D. General Practice Physician · Donalsonville, GA · NPI 1962842013

NPD
Joseph Lynn Walker, MD Surgery Physician · Donalsonville, GA · NPI 1396866943

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20170613002024	GA	Part B Supplier - Clinic/Group Practice	9739457896	Receives reassigned benefits from 8 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Donalsonville, GA

National Provider Directory

Part of: Southwest Georgia Healthcare Clinics Inc

Locations

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

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Obstetrics & Gynecology Physician Group: 193200000X MULTI-SPECIALTY GROUP	207V00000X
Federally Qualified Health Center (FQHC)	261QF0400X			Yes

Addresses

Primary practice location

900 N Wiley Ave
Donalsonville, GA 39845-1127

Mailing address

900 N Wiley Ave
Donalsonville, GA 39845-1127
Phone (229) 524-8489

Other names

Southwest Georgia Healthcare Clinics,inc Doing business as
Southwest Georgia Healthcare Clinics Women's Ctn Former legal business name

Other providers in Donalsonville, GA

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

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2021. 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.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.