PREMIERE HEALTH & WELLNESS LLC NPI 1316658990

NPI Information

  • NPI: 1316658990
  • Provider Name: PREMIERE HEALTH & WELLNESS LLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 11D2276140
  • Address: 1710 1/2 ALICE ST
    WAYCROSS, GA
    ZIP 31501
  • Phone: (912) 809-2341

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NPI Details

PREMIERE HEALTH & WELLNESS LLC is a family nurse practitioner in Waycross, GA. PREMIERE HEALTH & WELLNESS LLC NPI is 1316658990. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1710 1/2 ALICE ST
WAYCROSS, GA
ZIP 31501-216
Phone: (912) 809-2341
Fax: (912) 809-2432

The provider's authorized official is Dawn Driggers .
The authorized official title is Owner and has the following contact phone number (912) 614-3768.

The CLIA number assigned to this NPI record is 11D2276140 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/5/2022 and was last updated on 1/25/2023.

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
1363LF0000XNurse PractitionerFamilyYes

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
1003206327AMEDICAIDGEORGIA

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: 3/30/2025

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