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General NPI Number Information
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NPI Number | 1902097520
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Entity Type | Organization
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Legal Business Name | AMERICUS INJURY AND WELLNESS CENTER
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 1526 ELM AVE
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City | AMERICUS
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State | GA
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Zip | 31709-4554
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Country | US
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Telephone | 229-928-0424
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Fax | 229-928-0250
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Provider Business Mailing Address
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Address Line | 1526 ELM AVE
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City | AMERICUS
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State | GA
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Zip | 31709-4554
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Country | US
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Telephone | 229-928-0424
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Fax | 229-928-0250
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS KRISTI FAULK JACKSON
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Credential |
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Telephone | 229-928-0424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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