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General NPI Number Information
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NPI Number | 1013908201
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Entity Type | Organization
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Legal Business Name | HEALTHMARK OF WALTON RURAL HEALTH CLINIC INC
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 4415 US HIGHWAY 331 S
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-6307
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Country | US
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Telephone | 850-951-4640
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Fax | 850-892-7079
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Provider Business Mailing Address
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Address Line | 4415 US HIGHWAY 331 S
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-6307
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Country | US
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Telephone | 850-951-4640
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Fax | 850-892-7079
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Authorized Official
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Title or Position | COO
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Name | MS. LISA SHIRLEY HOLLEY
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Credential |
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Telephone | 850-951-4507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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