Organization
J C LEWIS PRIMARY HEALTH CARE CENTER, INC
Active
Parent organization
J C LEWIS PRIMARY HEALTH CARE CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
J C LEWIS PRIMARY HEALTH CARE CENTER
Authorized official
LAURA ADAMS (CHIEF FINANCIAL OFFICER)
(912) 495-8887
Entity
Organization
Contact information
Practice address
3100 MONTGOMERY ST, SAVANNAH, GA 31405-3212
(912) 495-8887
(912) 495-8881
Mailing address
125 FAHM ST, SAVANNAH, GA 31401-2391
(912) 495-8887
(912) 495-8881
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003122845A
—
GA
01
—
111961
MEDICARE PTAN
GA
Enumeration date
07/15/2016
Last updated
07/29/2016
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