Healthcare Provider Details

I. General information

NPI: 1508453994
Provider Name (Legal Business Name): J C LEWIS PRIMARY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MALL ANX
SAVANNAH GA
31406-4738
US

IV. Provider business mailing address

PO BOX 13577
SAVANNAH GA
31416-0577
US

V. Phone/Fax

Practice location:
  • Phone: 912-721-6735
  • Fax:
Mailing address:
  • Phone: 912-495-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. HILTON FORDHAM
Title or Position: HR DIRECTOR
Credential:
Phone: 912-721-6706