Organization
J.C. LEWIS PRIMARY HEALTHCARE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENA DOUSE (CEO)
(912) 721-6701
Entity
Organization
Contact information
Practice address
5 MALL ANX, SAVANNAH, GA 31406-4738
(912) 721-6701
(912) 495-8881
Mailing address
5 MALL ANX, SAVANNAH, GA 31406-4738
(912) 721-6705
(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
—
003104809A
—
GA
05
—
003110256A
—
GA
05
—
003122845A
—
GA
05
—
003122855A
—
GA
05
—
003135130A
—
GA
05
—
003156658A
—
GA
Enumeration date
12/06/2010
Last updated
09/06/2024
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