Provider Demographics
NPI:1508205006
Name:C-WORTH FAMILY WALK-IN CLINIC
Entity Type:Organization
Organization Name:C-WORTH FAMILY WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:706-517-0656
Mailing Address - Street 1:2976 HIGHWAY 76
Mailing Address - Street 2:STE B
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-6981
Mailing Address - Country:US
Mailing Address - Phone:706-517-0656
Mailing Address - Fax:706-517-0651
Practice Address - Street 1:2976 HIGHWAY 76
Practice Address - Street 2:STE B
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-6981
Practice Address - Country:US
Practice Address - Phone:706-517-0656
Practice Address - Fax:706-517-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097481261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care