| Parkway Family Medicine Llc | |
|
122 Canal St Ste 102 Pooler GA 31322-4408 | |
| (912) 450-0999 | |
| (912) 450-0999 |
| Full Name | Parkway Family Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 122 Canal St Ste 102, Pooler, Georgia |
| Authorized Official Name and Position | Ludella Brown (ADVANCED PRACTICE NURSE) |
| Authorized Official Contact | 9124500999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Parkway Family Medicine Llc 122 Canal St Ste 102 Pooler GA 31322-4408 Ph: (912) 450-0999 | Parkway Family Medicine Llc 122 Canal St Ste 102 Pooler GA 31322-4408 Ph: (912) 450-0999 |
| NPI Number | 1730486598 |
|---|---|
| Provider Enumeration Date | 02/14/2011 |
| Last Update Date | 08/03/2023 |
| Medicare PECOS PAC ID | 9032392972 |
|---|---|
| Medicare Enrollment ID | O20110330000472 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730486598 | NPI | - | NPPES |
| 153640219H | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | RN064864 (Georgia) | Primary |
| Provider Name | Ludella Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700999760 PECOS PAC ID: 3678513058 Enrollment ID: I20050504001195 |
| Provider Name | Daisy Gupta |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437471968 PECOS PAC ID: 3779614839 Enrollment ID: I20101025000674 |
| Provider Name | Jacqueline A Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942578737 PECOS PAC ID: 7517126725 Enrollment ID: I20120307000786 |
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