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General NPI Number Information
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NPI Number | 1376758581
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Entity Type | Organization
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Legal Business Name | POOLER PARKWAY INTERNAL MEDICINE, LLC
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 143 CANAL ST SUITE 100
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City | POOLER
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State | GA
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Zip | 31322-6007
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Country | US
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Telephone | 912-330-5149
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Fax |
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Provider Business Mailing Address
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Address Line | 143 CANAL ST SUITE 100
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City | POOLER
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State | GA
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Zip | 31322-6007
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Country | US
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Telephone | 912-330-5149
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | PATTY PIERCE
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Credential |
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Telephone | 912-330-5143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 39698
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License Number State | GA
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