Healthcare Provider Details

I. General information

NPI: 1689704108
Provider Name (Legal Business Name): HWC THERAPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BANKS STA
FAYETTEVILLE GA
30214-7505
US

IV. Provider business mailing address

215 BANKS STA
FAYETTEVILLE GA
30214-7505
US

V. Phone/Fax

Practice location:
  • Phone: 770-719-4949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: GILBERT OSBORNE
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 770-719-4949