Practitioner Direct Global, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PRACTITIONER DIRECT GLOBAL, LLC

Doing business as

PDG Healthcare & Staffing

Practice address

1125 West St Ste 401
Annapolis, MD 21401-4198

Phone

(410) 934-3494

NPI assigned

Nov 26, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Constance Fullwood, DNP/PHNL, PMHNP-BCNPI 1134798663

Title

Ceo/Nurse Practitioner

Phone

(401) 934-3494

Specialties & licenses 1

Addresses

Other names 1

• PDG Healthcare & Staffing Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Constance Fullwood, PHNL, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Long Island City, NY
  • NPI 1134798663
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1023834850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7831 OLD NORTH CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282702782",
            "telephone_number": "704-998-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 WEST ST STE 401",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214014198",
            "telephone_number": "410-934-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRACTITIONER DIRECT GLOBAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-26",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "FULLWOOD",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_title_or_position": "CEO/NURSE PRACTITIONER",
        "authorized_official_telephone_number": "401-934-3494",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP/PHNL, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDG Healthcare & Staffing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Danielle Powell, LC, DOULA
• Kimone Powell, M.D.
• Erin Powers, MD
• George Powers
• Kaylan Powers
• Christopher Pradia
• Erika Pratt
• Precision Orthopedics and Sports Medicine
• Michelle Preedy
• Premier MRI Services LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Annapolis, MD
• Providers in Annapolis, MD by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.