Provider Demographics
NPI:1376756023
Name:CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRAIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EARLENE
Authorized Official - Middle Name:JOINER
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-527-1088
Mailing Address - Street 1:106 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-2917
Mailing Address - Country:US
Mailing Address - Phone:912-527-1000
Mailing Address - Fax:
Practice Address - Street 1:2 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31408-3524
Practice Address - Country:US
Practice Address - Phone:912-527-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0059353336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000326466AMedicaid
GA000048475Medicare Oscar/Certification