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Organization

MISTY D. POOLE, MD, LLC

Active
Other names
Vidalia Internal Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
MISTY D POOLE MD (OWNER)
(912) 537-2200
Entity
Organization

Contact information

Practice address
210 MOSE COLEMAN DR, VIDALIA, GA 30474-8677
(912) 537-2200
(912) 537-2260
Mailing address
210 MOSE COLEMAN DR, VIDALIA, GA 30474-8677
(912) 537-2200
(912) 537-2260

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2021111317
MEDICARE
GA
Enumeration date
05/17/2012
Last updated
10/09/2015
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