Provider Demographics
NPI:1346722964
Name:FJP MEDICAL
Entity Type:Organization
Organization Name:FJP MEDICAL
Other - Org Name:POWELL TOTAL MEDICAL AND SERENITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-729-7246
Mailing Address - Street 1:140 THE LAKES BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6814
Mailing Address - Country:US
Mailing Address - Phone:912-729-7246
Mailing Address - Fax:912-729-2929
Practice Address - Street 1:140 THE LAKES BLVD STE C
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6814
Practice Address - Country:US
Practice Address - Phone:912-729-7246
Practice Address - Fax:912-729-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65488261QH0100X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service