Provider Demographics
NPI:1952567711
Name:ENSLEY PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:ENSLEY PRIMARY CARE, INC.
Other - Org Name:GREENSBORO FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-453-0046
Mailing Address - Street 1:1330 PARKS MILL DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-3241
Mailing Address - Country:US
Mailing Address - Phone:706-453-0046
Mailing Address - Fax:
Practice Address - Street 1:1190 SILOAM RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-2840
Practice Address - Country:US
Practice Address - Phone:706-453-0046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00801765CMedicaid
GA08BBVBZMedicare PIN
GAG80074Medicare UPIN