Organization
POOLER PARKWAY INTERNAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATTY PIERCE (PRACTICE MANAGER)
(912) 330-5143
Entity
Organization
Contact information
Practice address
143 CANAL ST, SUITE 100, POOLER, GA 31322-6007
(912) 330-5149
Mailing address
143 CANAL ST, SUITE 100, POOLER, GA 31322-6007
(912) 330-5149
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39698
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932129822
MICHELLE L. WILSON, DO
GA
Enumeration date
05/11/2007
Last updated
08/22/2020
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