Provider Demographics
NPI:1497766521
Name:WINDER ADULT PRIMARY CARE & WELLNESS, INC
Entity Type:Organization
Organization Name:WINDER ADULT PRIMARY CARE & WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-867-0455
Mailing Address - Street 1:3025 BRECKINRIDGE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7611
Mailing Address - Country:US
Mailing Address - Phone:678-226-0022
Mailing Address - Fax:
Practice Address - Street 1:314 N BROAD ST
Practice Address - Street 2:SUITE 350
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2191
Practice Address - Country:US
Practice Address - Phone:770-867-0455
Practice Address - Fax:770-867-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP5131Medicare PIN