Appling Total Wellness, LLC
Organization Active NPI Family Medicine Physician · Baxley, GA
NPI 1346962248 · NPPES record last updated Sep 16, 2022
Key facts
- NPI
- 1346962248
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- APPLING TOTAL WELLNESS, LLC
- Practice address
- 1745 City Circle Rd BLDG B
Baxley, GA 31513-7059 - Phone
- (912) 705-1939
- NPI assigned
- Sep 16, 2022
- Organization subpart
- No
Authorized official
- Name
- Mrs. Amanda Nicole Deen, MSN, FNP-BC
- Title
- FNP-BC
- Phone
- (912) 387-5557
Practitioners 4
-
Nizar Eskandar, M.D.
-
Amanda Nicole Deen, MSN, FNP-BC
-
Paige Tomberlin, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2275760 | Appling Total Wellness LLC | Certificate of waiver | Jan 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230113002159 | GA | Part B Supplier - Clinic/Group Practice | 6406227255 |
Receives reassigned benefits from 4 practitioners Practice locations: Baxley, GA |
National Provider Directory
Locations
1745 City Circle Rd
Bldg B
Baxley, GA 31513
Phone (912) 705-1939
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1745 City Circle Rd BLDG B
Baxley, GA 31513-7059
Mailing address
1745 City Circle Rd BLDG B
Baxley, GA 31513-7059
Other providers in Baxley, GA
- Appling County Board of Education
- Appling County Board of Health
- Appling Eye Clinic,Inc.
- Appling Eye Clinic.Inc.
- Appling Family Total Healthcare, P.C.
- Michael Dustin Arnold
- Briana Baxley Aycock
- Barjinder Singh,MD
- Barnes Drug Store, LLC
- Mark Tollison Barnes
All providers in Baxley, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.