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General NPI Number Information
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NPI Number | 1568919421
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Entity Type | Organization
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Legal Business Name | INJURED WORKERS ASSISTANCE NETWORK
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 1657 PHOENIX BLVD SUITE 5
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5554
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Country | US
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Telephone | 713-539-8175
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Fax |
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Provider Business Mailing Address
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Address Line | 1657 PHOENIX BLVD SUITE 5
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5554
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Country | US
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Telephone | 713-539-8175
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Fax |
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | WINSTON TOLLETT
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Credential |
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Telephone | 713-539-8175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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