Healthcare Provider Details

I. General information

NPI: 1891859849
Provider Name (Legal Business Name): BREMEN FAMILY HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 ALABAMA AVE S
BREMEN GA
30110-2007
US

IV. Provider business mailing address

509 ALABAMA AVE S
BREMEN GA
30110-2007
US

V. Phone/Fax

Practice location:
  • Phone: 770-537-5555
  • Fax: 770-537-0548
Mailing address:
  • Phone: 770-537-5555
  • Fax: 770-537-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2627
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN150905
License Number StateGA

VIII. Authorized Official

Name: RALPH J TEMPLETON
Title or Position: CEO
Credential:
Phone: 770-537-5555