Provider Demographics
NPI:1750734372
Name:J C LEWIS PRIMARY HEALTHCARE CENTER INC
Entity type:Organization
Organization Name:J C LEWIS PRIMARY HEALTHCARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-721-6704
Mailing Address - Street 1:5 MALL ANX
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4738
Mailing Address - Country:US
Mailing Address - Phone:912-721-6704
Mailing Address - Fax:912-495-8881
Practice Address - Street 1:3802 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6210
Practice Address - Country:US
Practice Address - Phone:912-352-3845
Practice Address - Fax:912-354-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003104809AMedicaid