Provider Demographics
NPI:1043618259
Name:ANNUAL WELLNESS CENTERS OF AMERICA
Entity Type:Organization
Organization Name:ANNUAL WELLNESS CENTERS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-503-0021
Mailing Address - Street 1:3030 MCEVER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5579
Mailing Address - Country:US
Mailing Address - Phone:770-503-0021
Mailing Address - Fax:
Practice Address - Street 1:3030 MCEVER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5579
Practice Address - Country:US
Practice Address - Phone:770-503-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center