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General NPI Number Information
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NPI Number | 1477728996
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Entity Type | Organization
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Legal Business Name | PERRY PARK NEIGHBORHOOD CLINIC, INC.
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 2211 BARTOW ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-5604
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Country | US
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Telephone | 912-265-8131
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Fax | 912-265-1140
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Provider Business Mailing Address
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Address Line | 2211 BARTOW ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-5604
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Country | US
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Telephone | 912-265-8131
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Fax | 912-265-1140
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | CATHY SLAY-CHIPP
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Credential | APRN-C
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Telephone | 912-265-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | RN051489
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License Number State | GA
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