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General NPI Number Information
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NPI Number | 1518788959
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Entity Type | Organization
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Legal Business Name | NUMI WELLNESS AND DIABETES CENTER LLC
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1525 FAIR RD STE 105A
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City | STATESBORO
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State | GA
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Zip | 30458-6118
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Country | US
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Telephone | 276-591-8383
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Fax | 912-259-9509
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Provider Business Mailing Address
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Address Line | 1525 FAIR RD STE 105A
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City | STATESBORO
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State | GA
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Zip | 30458-6118
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASON HOLLIS
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Credential | DO
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Telephone | 276-591-8383
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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