# WAY MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Way Medical Group LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386365476
- **Authorized official:** DR. JAY BOULDIN (CEO)
- **Authorized official phone:** (321) 989-2187

## Contact information

- **Practice address:** 4780 DAIRY RD, MELBOURNE, FL 32904-8482
- **Practice address phone:** (321) 989-2187
- **Mailing address:** 4780 DAIRY RD, MELBOURNE, FL 32904-8482
- **Mailing address phone:** (321) 989-2187

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 246Z00000X | Other Specialist/Technologist | — | NULL | — |
| 246Z00000X | Other Specialist/Technologist | — | — | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |
| 261QR1100X | Research Clinic/Center | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/07/2022
- **Last updated:** 07/26/2023