Provider Demographics
NPI:1043089998
Name:SOUTHBRDGE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:SOUTHBRDGE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:AGYEI
Authorized Official - Last Name:AGYEMANG
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, ANP-BC
Authorized Official - Phone:912-800-9220
Mailing Address - Street 1:851 SOUTHBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-1096
Mailing Address - Country:US
Mailing Address - Phone:912-657-5256
Mailing Address - Fax:
Practice Address - Street 1:476 RIVERSIDE AVE # 1905
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-4912
Practice Address - Country:US
Practice Address - Phone:904-800-9220
Practice Address - Fax:904-674-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health