Provider Demographics
NPI:1063112035
Name:JUDAH HEALTH AND WELLNESS URGENT CARE
Entity type:Organization
Organization Name:JUDAH HEALTH AND WELLNESS URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEIKEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:478-363-5399
Mailing Address - Street 1:99 OLD MILL CT
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-6643
Mailing Address - Country:US
Mailing Address - Phone:478-363-5399
Mailing Address - Fax:912-493-5075
Practice Address - Street 1:99 OLD MILL CT
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-6643
Practice Address - Country:US
Practice Address - Phone:478-363-5399
Practice Address - Fax:912-493-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003240898FMedicaid