Organization Active NPI

Family Medicine of Pooler, LLC

  • Primary Care Clinic/Center
  • Pooler, GA
National Provider Identifier
1275848533
Registry record updated Aug 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
056554 Issued in GA
Legal business name
FAMILY MEDICINE OF POOLER, LLC
Practice address
433 US Highway 80 W
Pooler, GA 31322-2509
Phone
(912) 748-1100
Fax
(912) 748-1004
NPI assigned
Aug 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2010

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

Authorized official

Name
Dr. Christi Marie Ghaleb, M.D.
Title
Co-Owner
Phone
(912) 303-9907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 056554 GA Primary

Addresses

Primary practice location

433 US Highway 80 W
Pooler, GA 31322-2509

Mailing address

433 US Highway 80 W
Pooler, GA 31322-2509
Phone (912) 748-1100

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2014321Family Medicine of Pooler, LLC433 US Highway 80 US, Pooler, GA 31322Certificate of waiverOct 5, 2026

National Provider Directory

National Provider Directory

Locations

433 US Highway 80 W
Pooler, GA 31322
Phone (912) 348-0533

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1275848533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 US HIGHWAY 80 W",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313222509",
            "telephone_number": "912-748-1100",
            "fax_number": "912-748-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 US HIGHWAY 80 W",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313222509",
            "telephone_number": "912-748-1100",
            "fax_number": "912-748-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE OF POOLER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-11",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "GHALEB",
        "authorized_official_first_name": "CHRISTI",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "912-303-9907",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "056554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pooler, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.