PARKWAY FAMILY MEDICINE LLC NPI 1730486598

NPI Information

NPI: 1730486598
Provider Name: PARKWAY FAMILY MEDICINE LLC

Former Legal Business Name: WOMENS HEALTHCARE AND FAMILY MEDICINE

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 11D2190836

Address:
122 CANAL ST STE 102
POOLER, GA
ZIP 31322
Phone: (912) 450-0999
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PARKWAY FAMILY MEDICINE LLC is a primary care clinic center in Pooler, GA. PARKWAY FAMILY MEDICINE LLC NPI is 1730486598. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Womens Healthcare And Family Medicine.

The provider's business location address is:

122 CANAL ST STE 102
POOLER, GA
ZIP 31322-408
Phone: (912) 450-0999
Fax: (912) 450-0999

The provider's authorized official is Ludella Brown .
The authorized official title is Advanced Practice Nurse and has the following contact phone number (912) 450-0999.

The CLIA number assigned to this NPI record is 11D2190836 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/14/2011 and was last updated on 8/3/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	RN064864	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	153640219H	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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