Provider Demographics
NPI:1790427268
Name:YOUR CHOICE HEALTHCARE- BAXLEY, P.C
Entity Type:Organization
Organization Name:YOUR CHOICE HEALTHCARE- BAXLEY, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OF SUBCORP
Authorized Official - Prefix:
Authorized Official - First Name:GRE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:912-705-9680
Mailing Address - Street 1:388 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0104
Mailing Address - Country:US
Mailing Address - Phone:912-705-9680
Mailing Address - Fax:912-705-0531
Practice Address - Street 1:388 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0104
Practice Address - Country:US
Practice Address - Phone:912-705-9680
Practice Address - Fax:912-705-0531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR CHOICE HEALTHCARE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-13
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003120968AMedicaid