Basic Information
| Provider Information | |||||||||
| NPI: | 1053488734 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNION MISSION, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 FAHM ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314012392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122367423 | ||||||||
| FaxNumber: | 9122363907 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 FAHM ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314012391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124958887 | ||||||||
| FaxNumber: | 9124958889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9122367423 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 000917199A | 05 | GA | MEDICAID |