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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