Provider Demographics
NPI:1861954653
Name:FAMILY WELLNESS CENTER GCS INC
Entity type:Organization
Organization Name:FAMILY WELLNESS CENTER GCS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-621-0247
Mailing Address - Street 1:3189 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9371
Mailing Address - Country:US
Mailing Address - Phone:904-621-0247
Mailing Address - Fax:904-339-9945
Practice Address - Street 1:3189 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-9371
Practice Address - Country:US
Practice Address - Phone:904-621-0247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty