Provider Demographics
NPI:1275848533
Name:FAMILY MEDICINE OF POOLER, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF POOLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GHALEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-303-9907
Mailing Address - Street 1:433 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2509
Mailing Address - Country:US
Mailing Address - Phone:912-748-1100
Mailing Address - Fax:912-748-1004
Practice Address - Street 1:433 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2509
Practice Address - Country:US
Practice Address - Phone:912-748-1100
Practice Address - Fax:912-748-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056554261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care