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Organization
THELWELL IMMEDIATE CARE CLINIC INC
Active
Organization
THELWELL IMMEDIATE CARE CLINIC INC
Active
Other names
Thelwell Immediate Care Clinic Inc
Organization subpart
No
Provider details
NPI number
Authorized official
ENOMA EVBUOMWAN PA-C (PHYSICIAN ASSISTANT)
(646) 402-1122
Entity
Organization
Contact information
Practice address
1400 VETERANS MEMORIAL HIGHWAY SE SUITE 134 #176, MABLETON, GA 30126
(646) 402-1122
Mailing address
1400 VETERANS MEMORIAL HIGHWAY SE SUITE 134 #176, MABLETON, GA 30126
(646) 402-1122
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
261QV0200X
VA Clinic/Center
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
10/14/2019
Last updated
10/14/2019
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