Provider Demographics
NPI:1750135745
Name:JC WELLNESS CENTER LLC
Entity type:Organization
Organization Name:JC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANYANWU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:470-414-0554
Mailing Address - Street 1:903 PAVILION CT STE D
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6672
Mailing Address - Country:US
Mailing Address - Phone:470-414-0554
Mailing Address - Fax:
Practice Address - Street 1:903 PAVILION CT STE D
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6672
Practice Address - Country:US
Practice Address - Phone:470-414-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty