Organization
PREMIER UROGYNECOLOGY OF TALLAHASSEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA JORDAN (PROVIDER ENROLLMENT COORDINATOR)
(229) 891-9131
Entity
Organization
Contact information
Practice address
1963 VILLAGE GREEN WAY, TALLAHASSEE, FL 32308-3833
(229) 502-9788
Mailing address
PO BOX 2876, MOULTRIE, GA 31776-2876
(229) 891-9131
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
—
—
Other
Enumeration date
10/21/2021
Last updated
10/21/2021
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