Healthcare Provider Details

I. General information

NPI: 1649574567
Provider Name (Legal Business Name): ALLWELL PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 N WILLIAMSBURG DR STE E
DECATUR GA
30033-3509
US

IV. Provider business mailing address

PO BOX 354
DECATUR GA
30031-0354
US

V. Phone/Fax

Practice location:
  • Phone: 404-499-0005
  • Fax:
Mailing address:
  • Phone: 404-499-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6244
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6244
License Number StateGA

VIII. Authorized Official

Name: DR. TEFYLON V CAMERON
Title or Position: CEO
Credential: D.C.
Phone: 404-499-0005