Healthcare Provider Details

I. General information

NPI: 1831112879
Provider Name (Legal Business Name): TOOMBS COUNTY WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 NW BROAD STREET
LYONS GA
30436-0308
US

IV. Provider business mailing address

PO BOX 308
LYONS GA
30436-0308
US

V. Phone/Fax

Practice location:
  • Phone: 912-526-9581
  • Fax: 912-526-9583
Mailing address:
  • Phone: 912-526-9581
  • Fax: 912-526-9583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: STARLA SUTTON
Title or Position: PSO
Credential:
Phone: 912-338-5263