Living Well House Calls LLC

Key facts

NPI

1043561095

Entity type

Organization (NPI type 2)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

217510 (GA)

Legal business name

LIVING WELL HOUSE CALLS LLC

Practice address

607 4TH St W
Darien, GA 31305-9362

Phone

(912) 580-0440

NPI assigned

Sep 29, 2012

Organization subpart

No

Authorized official

Name

Mrs. Joanne Ellen Bracewell, ARNP-C

Title

Owner

Phone

(912) 580-0440

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 29, 2012.

{
    "created_epoch": "1348876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348876800000",
    "number": "1043561095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 4TH ST W",
            "city": "DARIEN",
            "state": "GA",
            "postal_code": "313059362",
            "telephone_number": "912-580-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 4TH ST W",
            "city": "DARIEN",
            "state": "GA",
            "postal_code": "313059362",
            "telephone_number": "912-580-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL HOUSE CALLS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-29",
        "last_updated": "2012-09-29",
        "status": "A",
        "authorized_official_last_name": "BRACEWELL",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-580-0440",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ARNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "217510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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