Healthcare Provider Details

I. General information

NPI: 1194416982
Provider Name (Legal Business Name): PEEPLES HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 US HIGHWAY 80 SW
POOLER GA
31322-2541
US

IV. Provider business mailing address

761 MIDDLE COUNTRY RD
SELDEN NY
11784-2550
US

V. Phone/Fax

Practice location:
  • Phone: 912-508-6414
  • Fax:
Mailing address:
  • Phone: 631-736-4064
  • Fax:

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: JENNY NEWCOMB
Title or Position: CONTRACTING
Credential:
Phone: 631-736-4064