Basic Information
| Provider Information | |||||||||
| NPI: | 1518246966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRANKLIN C. FETTER FAMILY HEALTH CENTER, INC | ||||||||
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| OtherOrganizationName: | RURAL MISSION MIGRANT SITE-JOHNS ISLAND | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 NASSAU ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294035513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437224112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3429 CAMP CARE RD | ||||||||
| Address2: | |||||||||
| City: | JOHNS ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294557131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437681720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2011 | ||||||||
| LastUpdateDate: | 09/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | RAVENELL | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8437224112 | ||||||||
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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 | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.