Provider Demographics
NPI:1831112879
Name:TOOMBS COUNTY WELLNESS CENTER
Entity Type:Organization
Organization Name:TOOMBS COUNTY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSO
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-338-5263
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-0308
Mailing Address - Country:US
Mailing Address - Phone:912-526-9581
Mailing Address - Fax:912-526-9583
Practice Address - Street 1:714 NW BROAD STREET
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-0308
Practice Address - Country:US
Practice Address - Phone:912-526-9581
Practice Address - Fax:912-526-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3497Medicare ID - Type UnspecifiedCOUNTY MEDICARE BILLINE #
GAFLU134Medicare ID - Type UnspecifiedFLU BILLING #