Provider Demographics
NPI:1144774316
Name:GOLDEN ISLES PALLIATIVE CARE, INC.
Entity Type:Organization
Organization Name:GOLDEN ISLES PALLIATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:DI LANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-265-4735
Mailing Address - Street 1:1692 GLYNCO PKWY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6845
Mailing Address - Country:US
Mailing Address - Phone:912-265-4735
Mailing Address - Fax:912-289-9200
Practice Address - Street 1:1692 GLYNCO PKWY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-6845
Practice Address - Country:US
Practice Address - Phone:912-265-4735
Practice Address - Fax:912-289-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65178207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108870DMedicaid