ANNUAL MEDICARE WELLNESS EXAMS NPI 1164148755

NPI Information

NPI: 1164148755
Provider Name: ANNUAL MEDICARE WELLNESS EXAMS
Classification: Clinic/Center - 261QH0100X
Entity Type: Organization

Specialization: Health Service

CLIA Number: 11D2273531

Address:
1880 BRASELTON HWY STE 118
LAWRENCEVILLE, GA
ZIP 30043
Phone: (706) 761-6553
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ANNUAL MEDICARE WELLNESS EXAMS is a health service clinic center in Lawrenceville, GA. ANNUAL MEDICARE WELLNESS EXAMS NPI is 1164148755. The provider is registered as an organization entity type.

The provider's business location address is:

1880 BRASELTON HWY STE 118
LAWRENCEVILLE, GA
ZIP 30043-877
Phone: (706) 761-6553
Fax: (678) 804-1852

The provider's authorized official is Antonia Harris .
The authorized official title is Owner and has the following contact phone number (706) 761-6553.

The CLIA number assigned to this NPI record is 11D2273531 - independent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/14/2022 and was last updated on 11/11/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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