Provider Demographics
NPI:1679294227
Name:BCA GEORGIA, LLC
Entity type:Organization
Organization Name:BCA GEORGIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:HARPER
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-764-2455
Mailing Address - Street 1:PO BOX 1067
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1067
Mailing Address - Country:US
Mailing Address - Phone:912-764-2455
Mailing Address - Fax:912-764-7522
Practice Address - Street 1:1850 N COLUMBIA ST STE 3
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7113
Practice Address - Country:US
Practice Address - Phone:478-453-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology