Basic Information
| Provider Information | |||||||||
| NPI: | 1326307901 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCREVEN COUNTY FAMILY HEALTH CENTER, LLC | ||||||||
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| OtherOrganizationName: | SCREVEN COUNTY FAMILY HEALTH CENTER, PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 EAST DERENNE AVENUE | ||||||||
| Address2: | ATTN.: ALIA MIKE | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126441626 | ||||||||
| FaxNumber: | 9126445260 | ||||||||
| Practice Location | |||||||||
| Address1: | 459 GA HIGHWAY 119 S | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313293021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008276536 | ||||||||
| FaxNumber: | 9126445260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2012 | ||||||||
| LastUpdateDate: | 11/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | GUENTHNER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY OF SCREVEN COUNTY HOSPITA | ||||||||
| AuthorizedOfficialTelephone: | 3126278247 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.