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General NPI Number Information
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NPI Number | 1750829107
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE CLINIC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 4395 OGEECHEE RD 209
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City | SAVANNAH
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State | GA
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Zip | 31405-1249
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Country | US
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Telephone | 912-208-0726
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Fax | 912-228-3046
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Provider Business Mailing Address
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Address Line | 4395 OGEECHEE RD 209
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City | SAVANNAH
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State | GA
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Zip | 31405-1249
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Country | US
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Telephone | 912-208-0726
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Fax | 912-228-3046
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Authorized Official
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Title or Position | OWNER
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Name | EMERALD I HALL
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Credential |
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Telephone | 912-208-0726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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