Healthcare Provider Details

I. General information

NPI: 1417083387
Provider Name (Legal Business Name): EASTERN WELLNESS CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479-B HWY 17 SOUTH
RICHMOND HILL GA
31324
US

IV. Provider business mailing address

PO BOX 1308
RICHMOND HILL GA
31324-1308
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-4117
  • Fax: 912-756-4127
Mailing address:
  • Phone: 912-756-4117
  • Fax: 912-756-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number50768
License Number StateGA

VIII. Authorized Official

Name: MRS. ARKLISHA CHRISTINA HARRIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-756-4117