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General NPI Number Information
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NPI Number | 1164075347
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Entity Type | Organization
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Legal Business Name | GOLDEN ISLES HEALTHCARE,LLC
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 144 E OAK ST
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City | MC RAE
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State | GA
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Zip | 31055-4338
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Country | US
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Telephone | 229-868-7342
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Fax | 229-868-4344
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Provider Business Mailing Address
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Address Line | 144 E OAK ST
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City | MC RAE
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State | GA
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Zip | 31055-4338
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Country | US
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Telephone | 229-868-7342
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Fax | 229-868-4344
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Authorized Official
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Title or Position | NURSE PRACTIONER/ OWNER
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Name | VALARIE I WEBB
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Credential | NP-C
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Telephone | 229-868-7342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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