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General NPI Number Information
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NPI Number | 1649447673
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Entity Type | Organization
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Legal Business Name | WELLNESS FAMILY CLINIC
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 2317 AUSTELL RD SW
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City | MARIETTA
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State | GA
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Zip | 30008-4537
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Country | US
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Telephone | 678-213-3137
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Fax | 678-213-3139
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Provider Business Mailing Address
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Address Line | 2317 AUSTELL RD SW
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City | MARIETTA
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State | GA
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Zip | 30008-4537
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Country | US
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Telephone | 678-213-3137
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Fax | 678-213-3139
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Authorized Official
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Title or Position | FNP
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Name | MRS. CHIOMA OKEREKE
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Credential | MSN-NPC
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Telephone | 678-213-3137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | RN113110NP
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License Number State | GA
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