Healthcare Provider Details

I. General information

NPI: 1164075347
Provider Name (Legal Business Name): GOLDEN ISLES HEALTHCARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 E OAK ST
MC RAE GA
31055-4338
US

IV. Provider business mailing address

144 E OAK ST
MC RAE GA
31055-4338
US

V. Phone/Fax

Practice location:
  • Phone: 229-868-7342
  • Fax: 229-868-4344
Mailing address:
  • Phone: 229-868-7342
  • Fax: 229-868-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VALARIE I WEBB
Title or Position: NURSE PRACTIONER/ OWNER
Credential: NP-C
Phone: 229-868-7342