| East Georgia Healthcare Center, Inc. | |
|
118 E Broad St Mount Vernon GA 30445-3018 | |
| (478) 237-2638 | |
| (478) 237-9138 |
| Full Name | East Georgia Healthcare Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 118 E Broad St, Mount Vernon, Georgia |
| Authorized Official Name and Position | Jill R Sorrells (CFO) |
| Authorized Official Contact | 4782376262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Georgia Healthcare Center, Inc. 128 S Main St Swainsboro GA 30401-3618 Ph: (478) 237-6262 | East Georgia Healthcare Center, Inc. 118 E Broad St Mount Vernon GA 30445-3018 Ph: (478) 237-2638 |
| NPI Number | 1487892857 |
|---|---|
| Provider Enumeration Date | 01/23/2009 |
| Last Update Date | 08/04/2014 |
| Medicare PECOS PAC ID | 0547228686 |
|---|---|
| Medicare Enrollment ID | O20090219000122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487892857 | NPI | - | NPPES |
| 000632376K | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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