Provider Demographics
NPI:1750829107
Name:COMMUNITY CARE CLINIC
Entity Type:Organization
Organization Name:COMMUNITY CARE CLINIC
Other - Org Name:COMMUNITY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMERALD
Authorized Official - Middle Name:I
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-208-0726
Mailing Address - Street 1:4395 OGEECHEE RD
Mailing Address - Street 2:209
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-1249
Mailing Address - Country:US
Mailing Address - Phone:912-208-0726
Mailing Address - Fax:912-228-3046
Practice Address - Street 1:4395 OGEECHEE RD
Practice Address - Street 2:209
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-1249
Practice Address - Country:US
Practice Address - Phone:912-208-0726
Practice Address - Fax:912-228-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty