Provider Demographics
NPI:1497942486
Name:WINGS OF FEATHERS MEDICAL CLINIC
Entity Type:Organization
Organization Name:WINGS OF FEATHERS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-267-1922
Mailing Address - Street 1:PO BOX 2663
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-2663
Mailing Address - Country:US
Mailing Address - Phone:912-267-1922
Mailing Address - Fax:912-267-1437
Practice Address - Street 1:3226 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4225
Practice Address - Country:US
Practice Address - Phone:912-267-1922
Practice Address - Fax:912-267-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044861174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1C GRP 7031OtherMEDICARE GROUP
GA1C GRP 7031OtherMEDICARE GROUP