Provider Demographics
NPI:1033724323
Name:OCEANHORSE HEALTH AND WELLNESS CLINIC
Entity type:Organization
Organization Name:OCEANHORSE HEALTH AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAY-CHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:912-230-1556
Mailing Address - Street 1:4212 CORAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3016
Mailing Address - Country:US
Mailing Address - Phone:912-275-8165
Mailing Address - Fax:912-289-9450
Practice Address - Street 1:4212 CORAL PARK DR OFC
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3016
Practice Address - Country:US
Practice Address - Phone:912-275-8165
Practice Address - Fax:912-289-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-13
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003262258AMedicaid