1619742681 NPI number — CURTIS V. COOPER PRIMARY HEALTH CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619742681 NPI number — CURTIS V. COOPER PRIMARY HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619742681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 E BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31401-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-527-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2451 LITTLE NECK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGDALE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31302-9360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-527-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DANIELS
Authorized Official First Name:
EARLENE
Authorized Official Middle Name:
JOINER
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
912-527-1088

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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