Provider Demographics
NPI:1780037614
Name:J C LEWIS PRIMARY HEALTH CARE CENTER INC
Entity Type:Organization
Organization Name:J C LEWIS PRIMARY HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-721-6705
Mailing Address - Street 1:PO BOX 13577
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-0577
Mailing Address - Country:US
Mailing Address - Phone:912-495-8887
Mailing Address - Fax:912-495-8881
Practice Address - Street 1:2414 BULL ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-9113
Practice Address - Country:US
Practice Address - Phone:912-495-8887
Practice Address - Fax:912-495-8881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J C LEWIS PRIMARY HEALTH CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-15
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003122855AMedicaid
GA202G701304OtherMEDICARE PART B
GA111979OtherMEDICARE PART A