Healthcare Provider Details

I. General information

NPI: 1033567268
Provider Name (Legal Business Name): JOURNEYPURE PANHANDLE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22219 PANAMA CITY BEACH PKWY
PANAMA CITY FL
32413-3227
US

IV. Provider business mailing address

22219 PANAMA CITY BEACH PKWY
PANAMA CITY FL
32413-3227
US

V. Phone/Fax

Practice location:
  • Phone: 850-249-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number59359
License Number StateFL

VIII. Authorized Official

Name: KATHERINE BOWERS
Title or Position: DIRECTOR OF OP RCM
Credential:
Phone: 615-715-4214