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General NPI Number Information
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NPI Number | 1942047782
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Entity Type | Organization
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Legal Business Name | B WELL FAMILY PRACTICE
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Dates
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Enumeration Date | 07/10/2024
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 3343 US HIGHWAY 84 STE 103
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City | BLACKSHEAR
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State | GA
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Zip | 31516-2158
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Country | US
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Telephone | 912-807-9355
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Fax | 912-514-1222
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Provider Business Mailing Address
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Address Line | 3343 US HIGHWAY 84 STE 103
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City | BLACKSHEAR
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State | GA
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Zip | 31516-2158
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Country | US
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Telephone | 912-807-9355
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Fax | 912-514-1222
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Authorized Official
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Title or Position | CEO
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Name | KELLI BEARD
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Credential | NP
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Telephone | 912-807-9355
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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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