Fawaz Medical and Surgical Clinic, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

ME82523 Issued in ZZ

Legal business name

FAWAZ MEDICAL AND SURGICAL CLINIC, LLC

Practice address

962 US Highway 331 S
Defuniak Springs, FL 32435-3372

Phone

(850) 951-8800

NPI assigned

May 14, 2014

Organization subpart

No

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

Authorized official

Name

Janna Mauldin

Title

Office Manager

Phone

(850) 951-8800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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

• Fawzi Fawaz, M. D.

  • Family Medicine Physician
  • Defuniak Springs, FL
  • NPI 1932283389
  Medicare reassignment NPD
• Sharon L Shelton, DO

  • Family Medicine Physician
  • Edgewater, FL
  • NPI 1174594295
  NPD (past)

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400025600000",
    "number": "1801207626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "962 US HIGHWAY 331 S",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324353372",
            "telephone_number": "850-951-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "962 US HIGHWAY 331 S",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324353372",
            "telephone_number": "850-951-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAWAZ MEDICAL AND SURGICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-05-14",
        "status": "A",
        "authorized_official_last_name": "MAULDIN",
        "authorized_official_first_name": "JANNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "850-951-8800"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "ZZ",
            "license": "ME82523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candice Jade Earnest, RBT
• Emerald Coast Medical Services Inc
• Emerald Springs Family Counseling LLC
• Donna Shepherd Ennis, NURSE PRACTITIONER
• Joe R. Evans III, O.D.
• Fawzi Fawaz, M. D.
• Patricia A Ferman, MS, RD, LD
• Maria Loreto Fernandez Puig
• Kendall Lynton Fields, PHD, LMHC
• Fisher Pharmacy, Inc

• Multi-Specialty Clinic/Center in Defuniak Springs, FL
• Providers in Defuniak Springs, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.