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445 Northport Pkwy Port Wentworth GA 31407-9267 | |
(912) 645-9889 | |
(912) 228-3058 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 445 Northport Pkwy, Port Wentworth, Georgia |
Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | 445 Northport Pkwy Port Wentworth GA 31407-9267 Ph: (912) 645-9889 |
NPI Number | 1497429518 |
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Provider Enumeration Date | 08/03/2021 |
Last Update Date | 08/24/2022 |
Identifier | Type | State | Issuer |
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1497429518 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |