| Organization Name: | FAMILY MEDICINE OF POOLER, LLC |
| NPI Number: | 1275848533 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTI MARIE GHALEB (CO-OWNER) |
| Mailing Address: | 433 Us Highway 80 W Pooler |
| State: | GA US |
| Postal Code: | 313222509 |
| Phone Number: | 9127481100 |
| Fax Number: | 9127481004 |
| NPI Enumeration Date: | 08/11/2010 |
| NPI Last Update Date: | 08/11/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 056554 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |