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General NPI Number Information
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NPI Number | 1689704108
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Entity Type | Organization
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Legal Business Name | HWC THERAPY CENTER, INC.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 215 BANKS STA
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7505
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Country | US
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Telephone | 770-719-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 215 BANKS STA
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | GILBERT OSBORNE
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Credential |
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Telephone | 770-719-4949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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