Provider Demographics
NPI:1730486598
Name:PARKWAY FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:PARKWAY FAMILY MEDICINE LLC
Other - Org Name:WOMENS HEALTHCARE AND FAMILY MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE
Authorized Official - Prefix:
Authorized Official - First Name:LUDELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:APN, DNP
Authorized Official - Phone:912-450-0999
Mailing Address - Street 1:122 CANAL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4408
Mailing Address - Country:US
Mailing Address - Phone:912-450-0999
Mailing Address - Fax:912-450-0999
Practice Address - Street 1:122 CANAL ST STE 102
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4408
Practice Address - Country:US
Practice Address - Phone:912-450-0999
Practice Address - Fax:912-450-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN064864261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA153640219HMedicaid