Provider Demographics
NPI:1497842777
Name:ANWAN WELLNESS MEDICAL CENTER PC
Entity Type:Organization
Organization Name:ANWAN WELLNESS MEDICAL CENTER PC
Other - Org Name:DONOVAN W. CHRISTIE M.D.P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-761-2766
Mailing Address - Street 1:4514 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:STE. 328
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6202
Mailing Address - Country:US
Mailing Address - Phone:770-685-7879
Mailing Address - Fax:
Practice Address - Street 1:725 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1935
Practice Address - Country:US
Practice Address - Phone:404-761-2766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6644Medicare Oscar/Certification