Healthcare Provider Details

I. General information

NPI: 1154245231
Provider Name (Legal Business Name): COMPLETEMD OF GA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BLUE MOON XING STE 200
POOLER GA
31322-9696
US

IV. Provider business mailing address

900 MOHAWK ST STE E
SAVANNAH GA
31419-1768
US

V. Phone/Fax

Practice location:
  • Phone: 912-925-0067
  • Fax:
Mailing address:
  • Phone: 912-925-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PRISCILLA JONES
Title or Position: MANAGER
Credential:
Phone: 912-925-0067