Provider Demographics
NPI:1346590221
Name:STAR FAMILY HEALTHCARE AND WELLNESS CENTER
Entity Type:Organization
Organization Name:STAR FAMILY HEALTHCARE AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:UZOKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-510-3766
Mailing Address - Street 1:5337 OLD NATIONAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3208
Mailing Address - Country:US
Mailing Address - Phone:404-767-7777
Mailing Address - Fax:404-767-7770
Practice Address - Street 1:5337 OLD NATIONAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3208
Practice Address - Country:US
Practice Address - Phone:404-767-7777
Practice Address - Fax:404-767-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145805363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty