Healthcare Provider Details

I. General information

NPI: 1861316580
Provider Name (Legal Business Name): 912 HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N MAIN ST
BAXLEY GA
31513-0567
US

IV. Provider business mailing address

PO BOX 1578
BAXLEY GA
31515-1578
US

V. Phone/Fax

Practice location:
  • Phone: 912-253-5040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARSHALL HULETT
Title or Position: OWNER
Credential: FNP-BC
Phone: 912-253-5040