NPIMap

Organization Active NPI

Pooler Parkway Internal Medicine, LLC

  • Internal Medicine Physician
  • Pooler, GA
National Provider Identifier
1376758581
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
39698 Issued in GA
Legal business name
POOLER PARKWAY INTERNAL MEDICINE, LLC
Practice address
143 Canal St
Suite 100
Pooler, GA 31322-6007
Phone
(912) 330-5149
NPI assigned
May 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Patty Pierce
Title
Practice Manager
Phone
(912) 330-5143

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 39698 GA Primary

Addresses

Primary practice location

143 Canal St
Suite 100
Pooler, GA 31322-6007

Mailing address

143 Canal St
Suite 100
Pooler, GA 31322-6007
Phone (912) 330-5149

Other identifiers 1

IdentifierTypeStateIssuer
1932129822OtherGAMICHELLE L. WILSON, DO

National Provider Directory

National Provider Directory

Locations

143 Canal St
Ste 100
Pooler, GA 31322
Phone (912) 330-5149

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376758581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 CANAL ST",
            "address_2": "SUITE 100",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313226007",
            "telephone_number": "912-330-5149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 CANAL ST",
            "address_2": "SUITE 100",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313226007",
            "telephone_number": "912-330-5149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POOLER PARKWAY INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "PATTY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "912-330-5143"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "39698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHELLE L. WILSON, DO",
            "identifier": "1932129822",
            "state": "GA"
        }
    ],
    "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 22, 2020; 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.