Provider Demographics
NPI:1821718131
Name:WESLEY PRIMARY CARE
Entity Type:Organization
Organization Name:WESLEY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:O
Authorized Official - Last Name:FAMOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-431-8889
Mailing Address - Street 1:302 WESLEY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1741
Mailing Address - Country:US
Mailing Address - Phone:423-548-7007
Mailing Address - Fax:423-543-2273
Practice Address - Street 1:138 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-4644
Practice Address - Country:US
Practice Address - Phone:423-542-7007
Practice Address - Fax:423-543-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care