Provider Demographics
NPI:1841804598
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:CEO
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:912-527-1100
Mailing Address - Fax:
Practice Address - Street 1:244 LEDFORD STREET
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:GA
Practice Address - Zip Code:31321-3140
Practice Address - Country:US
Practice Address - Phone:912-527-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CURTIS V. COOPER PRIMARY HEALTH CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-01
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)