Provider Demographics
NPI:1376387340
Name:DOMINION HEALTH FAMILY WELLNESS CENTER
Entity type:Organization
Organization Name:DOMINION HEALTH FAMILY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-240-4500
Mailing Address - Street 1:4258 NC HIGHWAY 49 S UNIT 400
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-0107
Mailing Address - Country:US
Mailing Address - Phone:804-240-4500
Mailing Address - Fax:
Practice Address - Street 1:10310 MALLARD CREEK RD STE 101-D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4563
Practice Address - Country:US
Practice Address - Phone:980-431-4437
Practice Address - Fax:980-431-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty