Provider Demographics
NPI:1649447673
Name:WELLNESS FAMILY CLINIC
Entity type:Organization
Organization Name:WELLNESS FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKEREKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN-NPC
Authorized Official - Phone:678-213-3137
Mailing Address - Street 1:2317 AUSTELL RD SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-4537
Mailing Address - Country:US
Mailing Address - Phone:678-213-3137
Mailing Address - Fax:678-213-3139
Practice Address - Street 1:2317 AUSTELL RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4537
Practice Address - Country:US
Practice Address - Phone:678-213-3137
Practice Address - Fax:678-213-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113110NP261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA931772211BMedicaid
GA931772211BMedicaid