| Diversity Health Center Inc. | |
|
502 E General Stewart Way Ste A Hinesville GA 31313-2643 | |
| (912) 318-3947 | |
| (912) 877-0189 |
| Full Name | Diversity Health Center Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 502 E General Stewart Way Ste A, Hinesville, Georgia |
| Authorized Official Name and Position | Stephanie Jones-theaker (CEO) |
| Authorized Official Contact | 9123183947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diversity Health Center Inc. Po Box 1520 Hinesville GA 31310-8520 Ph: (912) 318-3947 | Diversity Health Center Inc. 502 E General Stewart Way Ste A Hinesville GA 31313-2643 Ph: (912) 318-3947 |
| NPI Number | 1326594714 |
|---|---|
| Provider Enumeration Date | 08/26/2016 |
| Last Update Date | 08/26/2016 |
| Medicare PECOS PAC ID | 9638261910 |
|---|---|
| Medicare Enrollment ID | O20110810000508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326594714 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 20843 (Georgia) | Primary |
| Provider Name | Floyd A Soriano |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1306845433 PECOS PAC ID: 7113980830 Enrollment ID: I20041104000439 |
| Provider Name | Fariborz A Zaer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427111020 PECOS PAC ID: 0446215016 Enrollment ID: I20041123000208 |
| Provider Name | David M Nussbaum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063440774 PECOS PAC ID: 3375592579 Enrollment ID: I20120425000462 |
| Provider Name | Jeannine Frazier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467961623 PECOS PAC ID: 9739448465 Enrollment ID: I20180125001284 |
| Provider Name | Sharifa Abou-mediene |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750571956 PECOS PAC ID: 2264795376 Enrollment ID: I20180423002857 |
| Provider Name | Heather Aileen Klein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639605678 PECOS PAC ID: 4082961784 Enrollment ID: I20180726002487 |
| Provider Name | Michelle Y Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528554375 PECOS PAC ID: 6305196940 Enrollment ID: I20180901000019 |
| Provider Name | Latonya Blevins Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568019081 PECOS PAC ID: 3173854189 Enrollment ID: I20191004002737 |
| Provider Name | Mark A Douglas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508475062 PECOS PAC ID: 6002234754 Enrollment ID: I20200914001014 |
| Provider Name | Andre Milton Singleton |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1669481412 PECOS PAC ID: 8921411539 Enrollment ID: I20201228001801 |
| Provider Name | Joan I Aura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811460975 PECOS PAC ID: 9133553092 Enrollment ID: I20210331001174 |
| Provider Name | Tiffiny M Duchene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033504543 PECOS PAC ID: 7416358379 Enrollment ID: I20210629002702 |
| Provider Name | Ketan Arvind Dhadphale |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851400121 PECOS PAC ID: 6507967874 Enrollment ID: I20211124000877 |
| Provider Name | Shikha Nandal |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1891364170 PECOS PAC ID: 5597131565 Enrollment ID: I20221017000052 |
| Provider Name | Holdunn Rutkoski |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1154947349 PECOS PAC ID: 0042638975 Enrollment ID: I20221109001860 |
| Provider Name | Tomeka Lashun Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548971302 PECOS PAC ID: 1658743778 Enrollment ID: I20230217001135 |
| Provider Name | Nakia S Ealy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083489454 PECOS PAC ID: 0840641593 Enrollment ID: I20240108003777 |
| Provider Name | Crystal Yvette Malloy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679958771 PECOS PAC ID: 8022469360 Enrollment ID: I20240110004725 |
Allied Health Systems Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 790 Frank Cochran Dr, Suite 111, Hinesville, GA 31313 Phone: 912-368-3868 | |
Hinesville Faimly Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 502 East General Stewart Way Suite A, Hinesville, GA 31313 Phone: 912-368-4169 Fax: 478-625-3667 | |
Liberty Regional Medical Center-walk-in Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 462 Elma G Miles Pkwy, Hinesville, GA 31313 Phone: 912-369-9310 Fax: 912-877-3102 | |
Bryan Medical Associates,inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 740 E General Stewart Way, Suite 103, Hinesville, GA 31313 Phone: 912-876-5452 | |
Hinesville Family Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 502 E General Stewart Way, Hinesville, GA 31313 Phone: 912-368-4169 Fax: 912-368-5667 | |
Liberty Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 455 S.main Street Ste 104, Hinesville, GA 31313 Phone: 912-876-5644 Fax: 912-408-3457 |