Provider Demographics
NPI:1417593955
Name:SAMANTHA MEEKS FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:SAMANTHA MEEKS FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:912-574-5819
Mailing Address - Street 1:17 PROFESSIONAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3784
Mailing Address - Country:US
Mailing Address - Phone:912-574-5838
Mailing Address - Fax:855-608-8655
Practice Address - Street 1:17 PROFESSIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3784
Practice Address - Country:US
Practice Address - Phone:912-574-5838
Practice Address - Fax:855-608-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care