Provider Demographics
NPI:1649574567
Name:ALLWELL PHYSICIANS
Entity Type:Organization
Organization Name:ALLWELL PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TEFYLON
Authorized Official - Middle Name:V
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-499-0005
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-0354
Mailing Address - Country:US
Mailing Address - Phone:404-499-0005
Mailing Address - Fax:
Practice Address - Street 1:1989 N WILLIAMSBURG DR STE E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3509
Practice Address - Country:US
Practice Address - Phone:404-499-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6244111N00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU74076Medicare UPIN