Provider Demographics
NPI:1972003879
Name:MEDICAL WELLNESS CENTER OF GEORGIA, LLC
Entity Type:Organization
Organization Name:MEDICAL WELLNESS CENTER OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:706-480-4322
Mailing Address - Street 1:1523 OLD VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:RAY CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31645-7132
Mailing Address - Country:US
Mailing Address - Phone:706-480-4322
Mailing Address - Fax:877-366-9625
Practice Address - Street 1:1523 OLD VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:RAY CITY
Practice Address - State:GA
Practice Address - Zip Code:31645-7132
Practice Address - Country:US
Practice Address - Phone:877-755-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty