Healthcare Provider Details

I. General information

NPI: 1063445971
Provider Name (Legal Business Name): WELLNESS FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 BOILING SPRINGS RD
SPARTANBURG SC
29303-2258
US

IV. Provider business mailing address

1241 BOILING SPRINGS RD
SPARTANBURG SC
29303-2258
US

V. Phone/Fax

Practice location:
  • Phone: 864-591-0992
  • Fax: 864-591-0776
Mailing address:
  • Phone: 864-591-0992
  • Fax: 864-591-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IRA GORDON EARLY
Title or Position: PRESIDENT
Credential: M.D., M.P.H.
Phone: 864-591-0992