Provider Demographics
NPI:1730695776
Name:CRITTENDEN FAMILY HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:CRITTENDEN FAMILY HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:CRITTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:706-325-4550
Mailing Address - Street 1:125 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7336
Mailing Address - Country:US
Mailing Address - Phone:678-519-0808
Mailing Address - Fax:678-519-0576
Practice Address - Street 1:125 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7336
Practice Address - Country:US
Practice Address - Phone:678-519-0808
Practice Address - Fax:678-519-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN106186261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care