Provider Demographics
NPI:1477728996
Name:PERRY PARK NEIGHBORHOOD CLINIC, INC.
Entity Type:Organization
Organization Name:PERRY PARK NEIGHBORHOOD CLINIC, INC.
Other - Org Name:PERRY PARK CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAY-CHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:912-265-8131
Mailing Address - Street 1:2211 BARTOW ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-5604
Mailing Address - Country:US
Mailing Address - Phone:912-265-8131
Mailing Address - Fax:912-265-1140
Practice Address - Street 1:2211 BARTOW ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-5604
Practice Address - Country:US
Practice Address - Phone:912-265-8131
Practice Address - Fax:912-265-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN051489261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center