Provider Demographics
NPI:1992809990
Name:PACER HEALTH MANAGEMENT CORPORATION OF GEORGIA
Entity type:Organization
Organization Name:PACER HEALTH MANAGEMENT CORPORATION OF GEORGIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-7660
Mailing Address - Street 1:1201 SILOAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-2811
Mailing Address - Country:US
Mailing Address - Phone:706-453-7331
Mailing Address - Fax:706-453-2812
Practice Address - Street 1:1201 SILOAM RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-2811
Practice Address - Country:US
Practice Address - Phone:706-453-7331
Practice Address - Fax:706-453-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAIN PROCESS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health