Healthcare Provider Details

I. General information

NPI: 1497766521
Provider Name (Legal Business Name): WINDER ADULT PRIMARY CARE & WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N BROAD ST SUITE 350
WINDER GA
30680-2191
US

IV. Provider business mailing address

3025 BRECKINRIDGE BLVD SUITE 120
DULUTH GA
30096-7611
US

V. Phone/Fax

Practice location:
  • Phone: 770-867-0455
  • Fax: 770-867-3990
Mailing address:
  • Phone: 678-226-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number047589
License Number StateGA

VIII. Authorized Official

Name: KARLA S DUNBAR
Title or Position: OWNER
Credential: M.D.
Phone: 770-867-0455