MEDICARE: WELLSPRINGS CENTER OF GOLDSBORO,P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023096088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRINGS CENTER OF GOLDSBORO,P.A.

Provider Business Mailing Address
First Line	:	2719 GRAVES DR
Second Line	:	SUITE 7
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-4536
Country	:	US
Telephone Number	:	919-583-8448
Fax Number	:	919-583-8449

Provider Business Practice Location Address
First Line	:	2719 GRAVES DR
Second Line	:	SUITE 7
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-4536
Country	:	US
Telephone Number	:	919-583-8448
Fax Number	:	919-583-8449

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. TAMARA TYNDALL JARMAN
Credential	:	LCSW
Telephone Number	:	919-583-8448

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	06/25/2009

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Directions to “WELLSPRINGS CENTER OF GOLDSBORO,P.A. ” Practice Location

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