Provider Demographics
NPI:1467711150
Name:WILLIAMSON HEALTH & WELLNESS CENTER INC
Entity Type:Organization
Organization Name:WILLIAMSON HEALTH & WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DONOVAN
Authorized Official - Last Name:BECKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-236-5902
Mailing Address - Street 1:PO BOX 2080
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-2080
Mailing Address - Country:US
Mailing Address - Phone:304-236-5902
Mailing Address - Fax:
Practice Address - Street 1:184 E 2ND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3602
Practice Address - Country:US
Practice Address - Phone:304-236-5902
Practice Address - Fax:855-487-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1875261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100283110Medicaid
WV1467711150Medicaid