# SOUTHBRDGE HEALTH AND WELLNESS LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043089998
- **Authorized official:** DORA AGYEI AGYEMANG MSN, APRN, ANP-BC (OWNER)
- **Authorized official phone:** (912) 800-9220

## Contact information

- **Practice address:** 476 RIVERSIDE AVE \# 1905, JACKSONVILLE, FL 32202-4912
- **Practice address phone:** (904) 800-9220
- **Practice address fax:** (904) 674-1843
- **Mailing address:** 851 SOUTHBRIDGE BLVD, SAVANNAH, GA 31405-1096
- **Mailing address phone:** (912) 657-5256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QI0500X | Infusion Therapy Clinic/Center | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2023
- **Last updated:** 12/20/2023