Basic Information
| Provider Information | |||||||||
| NPI: | 1336257179 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APPLECARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 MALL BLVD | ||||||||
| Address2: | SUITE 202E | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123494945 | ||||||||
| FaxNumber: | 9123494105 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 GLYNCO PKWY | ||||||||
| Address2: | BUILDING 1, SUITE 10 | ||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315257921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122649111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 02/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PATIENT SERVICES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9123494945 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | GRP6575 | 01 | GA | MEDICARE PTAN NUMBER | OTHER |