Provider Demographics
NPI:1780224352
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:COI
Authorized Official - Prefix:
Authorized Official - First Name:ATHELSTANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERAPHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-527-1130
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:
Mailing Address - Fax:
Practice Address - Street 1:3219 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5254
Practice Address - Country:US
Practice Address - Phone:912-527-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CURTIS V COOPER PRIMARY HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)