NPIMap

Organization Active NPI

Primary Care of Southwest Georgia, Inc

  • Federally Qualified Health Center (FQHC)
  • Thomasville, GA
National Provider Identifier
1992102073
Registry record updated Apr 6, 2015
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
Practice address
916 S Broad St
Unit B-2
Thomasville, GA 31792-6113
Phone
(229) 226-8800
Fax
(229) 226-2036
NPI assigned
Dec 4, 2014
Last updated
Apr 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2015

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

916 S Broad St
Unit B-2
Thomasville, GA 31792-6113

Mailing address

PO Box 1479
Thomasville, GA 31799-1479
Phone (229) 226-8800

Other identifiers 1

IdentifierTypeStateIssuer
003155529AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

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
This NPI is an additional NPI on the enrollment
Practice locations: Bainbridge, GA; Thomasville, GA; Quitman, GA; Blakely, GA

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Locations

916 S Broad St
Unit B2
Thomasville, GA 31792
Phone (229) 226-8800

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428278400000",
    "number": "1992102073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1479",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317991479",
            "telephone_number": "229-226-8800",
            "fax_number": "229-226-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 S BROAD ST",
            "address_2": "UNIT B-2",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926113",
            "telephone_number": "229-226-8800",
            "fax_number": "229-226-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF SOUTHWEST GEORGIA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-04",
        "last_updated": "2015-04-06",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003155529A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare 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.