Provider Demographics
NPI:1336502012
Name:COVENANT PRIMARY CARE
Entity Type:Organization
Organization Name:COVENANT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-927-8887
Mailing Address - Street 1:11700 MERCY BLVD # 3
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1753
Mailing Address - Country:US
Mailing Address - Phone:912-927-8887
Mailing Address - Fax:912-927-8064
Practice Address - Street 1:11700 MERCY BLVD # 3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-927-8887
Practice Address - Fax:912-927-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty