Organization · NPI-2
Diabetes Center Of Jesup LLC
Clinic/Center · Jesup, GA
NPI number1780445643
StatusActive
Last updated in NPPESJan 22, 2024
Details
- NPI
- 1780445643
- Entity type
- Organization (NPI-2)
- Legal business name
- Diabetes Center Of Jesup LLC
- Organization subpart
- No
- Enumeration date
- Jan 18, 2024
- Certification date
- Jan 22, 2024
- Last updated
- Jan 22, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Practice location
124 Memorial DrJesup, GA 31545-0101
Phone 912-750-0011 · Fax 833-740-4346
Mailing address
24 Glendale Ave Ste EBaxley, GA 31513-0245
Phone 123-102-3839
Authorized official
Randall Crawford
Owner
9123392342
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.