Healthcare Provider Details

I. General information

NPI: 1477460707
Provider Name (Legal Business Name): WELLSPRING MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 JEFFERSON PKWY # B
NEWNAN GA
30263-5822
US

IV. Provider business mailing address

184 JEFFERSON PKWY # B
NEWNAN GA
30263-5822
US

V. Phone/Fax

Practice location:
  • Phone: 404-759-9888
  • Fax:
Mailing address:
  • Phone: 404-759-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. EUGENE IFEANYICHUKWU OZIM
Title or Position: OWNER
Credential:
Phone: 770-316-0102