Healthcare Provider Details

I. General information

NPI: 1841432044
Provider Name (Legal Business Name): SCREVEN COUNTY FAMILY HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ROCKY FORD RD
SYLVANIA GA
30467-2027
US

IV. Provider business mailing address

460 MALL BLVD STE B
SAVANNAH GA
31406-4891
US

V. Phone/Fax

Practice location:
  • Phone: 912-564-7133
  • Fax: 912-564-2617
Mailing address:
  • Phone: 912-644-5300
  • Fax: 912-644-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number021262
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. DAVID ALEX VILLA
Title or Position: CEO
Credential:
Phone: 912-629-7797