Provider Demographics
NPI:1518728534
Name:ST GEORGE WALK IN CLINIC
Entity Type:Organization
Organization Name:ST GEORGE WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMIA
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:KOZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-630-3030
Mailing Address - Street 1:2709 KILLARNEY WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-6201
Mailing Address - Country:US
Mailing Address - Phone:850-630-3030
Mailing Address - Fax:850-999-8866
Practice Address - Street 1:2709 KILLARNEY WAY STE 3
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-6201
Practice Address - Country:US
Practice Address - Phone:850-630-3030
Practice Address - Fax:850-999-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty