Healthcare Provider Details

I. General information

NPI: 1679480149
Provider Name (Legal Business Name): PATIENTS FIRST LAKE ELLA MEDICAL CENTER P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 BAYOU BLVD
PENSACOLA FL
32503-2601
US

IV. Provider business mailing address

590 LANIER AVE W
FAYETTEVILLE GA
30214-1504
US

V. Phone/Fax

Practice location:
  • Phone: 850-332-4246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANDI FAULK
Title or Position: VP OF BILLING OPERATIONS
Credential:
Phone: 678-679-6471