Healthcare Provider Details

I. General information

NPI: 1912845249
Provider Name (Legal Business Name): FWC PERINATAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E 23RD ST
PANAMA CITY FL
32405-4501
US

IV. Provider business mailing address

5801 POSTAL RD
CLEVELAND OH
44181-2184
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-0338
  • Fax:
Mailing address:
  • Phone: 561-300-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY WALKER
Title or Position: CREDENTIALING
Credential:
Phone: 561-300-2410