=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336257179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 02/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 GLYNCO PKWY BUILDING 1, SUITE 10
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31525-7921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-264-9111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 MALL BLVD SUITE 202E
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31406-4862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-349-4945
-----------------------------------------------------
Fax | 912-349-4105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PATIENT SERVICES MANAGER
-----------------------------------------------------
Name | AMANDA JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 912-349-4945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------