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General NPI Number Information
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NPI Number | 1215254065
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Entity Type | Organization
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Legal Business Name | GOLDEN ISLES MEDICAL LLC
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Dates
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Enumeration Date | 05/03/2010
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 1015 ARTHUR J MOORE DR
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522-2206
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Country | US
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Telephone | 912-267-7780
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30062
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City | SEA ISLAND
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State | GA
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Zip | 31561-0062
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Country | US
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Telephone | 912-267-7780
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | DR. ANNA CABECA
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Credential | DO
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Telephone | 912-267-7780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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