Provider Demographics
NPI:1689950594
Name:SCREVEN COUNTY FAMILY HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:SCREVEN COUNTY FAMILY HEALTH CENTER, LLC
Other - Org Name:SCREVEN COUNTY FAMILY HEALTH CENTER, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY OF SCREVEN COUNTY HOSPITA
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUENTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-627-8247
Mailing Address - Street 1:210 EAST DERENNE AVENUE
Mailing Address - Street 2:ATTN.: ALIA MIKE
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-644-1626
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:215 MIMS RD
Practice Address - Street 2:SUITE 209-C
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-1994
Practice Address - Country:US
Practice Address - Phone:912-564-5977
Practice Address - Fax:912-564-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty