Provider Demographics
NPI:1093014532
Name:C-WORTH FAMILY WALK-IN CLINIC, LLC
Entity Type:Organization
Organization Name:C-WORTH FAMILY WALK-IN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:423-339-2321
Mailing Address - Street 1:2976 HIGHWAY 76
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-6981
Mailing Address - Country:US
Mailing Address - Phone:423-339-2320
Mailing Address - Fax:423-339-2321
Practice Address - Street 1:2976 HIGHWAY 76
Practice Address - Street 2:SUITE B & C
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-6981
Practice Address - Country:US
Practice Address - Phone:423-339-2320
Practice Address - Fax:423-339-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115578NP302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization