Healthcare Provider Details

I. General information

NPI: 1518788959
Provider Name (Legal Business Name): NUMI WELLNESS AND DIABETES CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 FAIR RD STE 105A
STATESBORO GA
30458-6118
US

IV. Provider business mailing address

1525 FAIR RD STE 105A
STATESBORO GA
30458-6118
US

V. Phone/Fax

Practice location:
  • Phone: 276-591-8383
  • Fax: 912-259-9509
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON HOLLIS
Title or Position: OWNER
Credential: DO
Phone: 276-591-8383