Provider Demographics
NPI:1083007355
Name:MBA COMMUNITY CLINIC
Entity Type:Organization
Organization Name:MBA COMMUNITY CLINIC
Other - Org Name:COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-335-8934
Mailing Address - Street 1:4395 OGEECHEE RD
Mailing Address - Street 2:STE 209
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-1249
Mailing Address - Country:US
Mailing Address - Phone:912-208-3261
Mailing Address - Fax:912-228-3046
Practice Address - Street 1:4395 OGEECHEE RD
Practice Address - Street 2:STE 209
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-1249
Practice Address - Country:US
Practice Address - Phone:912-335-8934
Practice Address - Fax:912-228-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service