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FAITH FAMILY PRACTICE LLC
NPI 1649819343
Family Medicine in Waycross, GA

Active since December 27, 2019CLIA 11D2177968 · Waiver
2100 RIVERSIDE AVE, WAYCROSS, GA 31501(912) 490-7777(912) 490-7778 Get Directions Write a Review

NPPES record last updated: January 8, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 8, 2026, Apr 23, 2020, Apr 14, 2020 and 2 more (5 updates tracked since 2019).

About Faith Family Practice Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAITH FAMILY PRACTICE LLC (NPI 1649819343) is a healthcare organization registered as a family medicine in Waycross, Georgia and active in the NPI registry since December 2019. The organization holds a CLIA Waiver certificate valid through January 22, 2028 and lists Mary Elizabeth Page, Owner, as its authorized official.

NPPES Registry Identity

NPI1649819343
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameFAITH FAMILY PRACTICE LLC
Location Address2100 RIVERSIDE AVEWaycross, GA 31501-7020
Mailing AddressPo Box 741Waycross, GA 31502-0741 · (912) 490-7777 · Fax (912) 490-7778
Phone(912) 490-7777
Fax(912) 490-7778
Organization SubpartNo
Authorized OfficialMary Elizabeth PageOwner · (912) 490-7777
Enumeration DateDecember 27, 2019
Last NPPES UpdateJanuary 8, 20265 updates tracked since enumeration
NPPES CertifiedJanuary 8, 2026
✔ NPI 1649819343 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
2100 RIVERSIDE AVE, Waycross, GA 31501
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Faith Family Practice Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Faith Family Practice LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Clay Lee, DO
Osteopathic Manipulative Medicine
NPI 1215901509
2100 RIVERSIDE AVE
Waycross, GA 31501
(912) 490-7777
✔ PECOS✔ Accepts MedicareSame address
Leanna Lewis, NP-C
Nurse Practitioner
NPI 1164796488
2100 RIVERSIDE AVE
Waycross, GA 31501
(912) 490-7777
✔ PECOS✔ Accepts MedicareSame address
Jerry Mullis, MD
Emergency Medicine
NPI 1851314975
2100 RIVERSIDE AVE
Waycross, GA 31501
(912) 490-7777
✔ PECOSSame address
Kristin Fenn, FNP
Nurse Practitioner
NPI 1134520984
1247 S 1ST ST
Jesup, GA 31545
(912) 385-2739
✔ PECOS✔ Accepts Medicare36 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2177968

Faith Family Practice · Waycross, GA
Active · expires Jan 22, 2028
CLIA Number11D2177968
Laboratory TypePhysician Office
Certificate Effective DateJanuary 23, 2026
Certificate Expiration DateJanuary 22, 2028
Laboratory DirectorClay Andrew Lee
Laboratory Phone(912) 490-7777
Laboratory LocationFaith Family Practice2100 Riverside Avenue, Waycross, GA 31501
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Faith Family Practice LLC's NPI number?

The NPI number for Faith Family Practice LLC is 1649819343. It was assigned to this organization in the NPPES registry on December 27, 2019.

Where is Faith Family Practice LLC located?

Faith Family Practice LLC is located at 2100 Riverside Ave, Waycross, GA 31501. The listed phone number is (912) 490-7777.

What is Faith Family Practice LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Faith Family Practice LLC enrolled in Medicare?

Yes. Faith Family Practice LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Faith Family Practice LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Faith Family Practice LLC, in Emergency Medicine, Nurse Practitioner and Osteopathic Manipulative Medicine. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Faith Family Practice LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2177968) is associated with this NPI, valid through January 22, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Faith Family Practice LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Faith Family Practice LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Faith Family Practice LLC was last updated on January 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.