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General NPI Number Information
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NPI Number | 1275848533
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE OF POOLER, LLC
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 433 US HIGHWAY 80 W
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City | POOLER
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State | GA
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Zip | 31322-2509
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Country | US
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Telephone | 912-748-1100
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Fax | 912-748-1004
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Provider Business Mailing Address
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Address Line | 433 US HIGHWAY 80 W
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City | POOLER
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State | GA
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Zip | 31322-2509
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Country | US
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Telephone | 912-748-1100
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Fax | 912-748-1004
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. CHRISTI MARIE GHALEB
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Credential | M.D.
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Telephone | 912-303-9907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 056554
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License Number State | GA
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