# WELLSPRING FAMILY MEDICAL CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538434311
- **Authorized official:** MRS. OLUBUNMI A AYENI REGISTERED NURSE (OFFICE MANAGER)
- **Authorized official phone:** (678) 289-8338

## Contact information

- **Practice address:** 2759 MOUNT ZION PKWY, SUITE 3, JONESBORO, GA 30236-2568
- **Practice address phone:** (678) 289-8338
- **Practice address fax:** (770) 603-0515
- **Mailing address:** 2759 MOUNT ZION PKWY STE C, JONESBORO, GA 30236-2568
- **Mailing address phone:** (678) 289-8338
- **Mailing address fax:** (770) 603-0515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 43534 | GA | Yes |

## Other

- **Enumeration date:** 03/13/2012
- **Last updated:** 03/12/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00794857C | — | GA |
| 05 | — | 00794857D | — | GA |