Provider Demographics
NPI:1740655158
Name:WELL CHILD OF GEORGIA, PLLC
Entity type:Organization
Organization Name:WELL CHILD OF GEORGIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-728-5858
Mailing Address - Street 1:650 NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5536
Mailing Address - Country:US
Mailing Address - Phone:901-728-5858
Mailing Address - Fax:901-531-6312
Practice Address - Street 1:650 NEW YORK ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5536
Practice Address - Country:US
Practice Address - Phone:901-728-5858
Practice Address - Fax:901-531-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty