Premier Urogynecology of Tallahassee

Primary specialty

Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X

Legal business name

PREMIER UROGYNECOLOGY OF TALLAHASSEE

Practice address

1963 Village Green Way
Tallahassee, FL 32308-3833

Phone

(229) 502-9788

NPI assigned

Oct 21, 2021

Organization subpart

No

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

Authorized official

Name

Sandra Jordan

Title

Provider Enrollment Coordinator

Phone

(229) 891-9131

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1992468482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2876",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762876",
            "telephone_number": "229-891-9131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1963 VILLAGE GREEN WAY",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323083833",
            "telephone_number": "229-502-9788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER UROGYNECOLOGY OF TALLAHASSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "229-891-9131"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Quin Prejean, CCC-SLP
• Premier Health and Wellness Tallahassee, LLC
• Premier Health Clinic & Rehabilitation Center of Tallahassee
• Premier Home Companion Services, LLC
• Premier Therapy Services
• Premium Medical Associates Healthcare LLC
• Premium Medical Associates Healthcare LLC
• Presbyterian Retirement Communities, Inc.
• Shaneka Dionne President, LCSW
• Patsy Dianne Presley, MSW, LCSW

• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; 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.