Provider Demographics
NPI:1043497274
Name:FAMILY WELLCARE CENTER
Entity Type:Organization
Organization Name:FAMILY WELLCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-653-6080
Mailing Address - Street 1:4215 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6889
Mailing Address - Country:US
Mailing Address - Phone:706-653-6080
Mailing Address - Fax:706-653-6052
Practice Address - Street 1:4215 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6889
Practice Address - Country:US
Practice Address - Phone:706-653-6080
Practice Address - Fax:706-653-6052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEVERLEY ATOWNSEND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028091261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA305491OtherWELLCARE
GA00396563IMedicaid
GA08BDMMTMedicare PIN
GA305491OtherWELLCARE