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General NPI Number Information
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NPI Number | 1497942486
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Entity Type | Organization
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Legal Business Name | WINGS OF FEATHERS MEDICAL CLINIC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 3226 HAMPTON AVE
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City | BRUNSWICK
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State | GA
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Zip | 31520-4225
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Country | US
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Telephone | 912-267-1922
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Fax | 912-267-1437
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Provider Business Mailing Address
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Address Line | PO BOX 2663
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City | BRUNSWICK
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State | GA
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Zip | 31521-2663
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Country | US
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Telephone | 912-267-1922
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Fax | 912-267-1437
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CYNTHIA R WARE
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Credential | M.D.
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Telephone | 912-267-1922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 044861
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License Number State | GA
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