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Organization

F&M WELLNESS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MELISSA BROSKE JACOME FNP-C (NURSE PRACTITIONER)
(706) 294-6485
Entity
Organization

Contact information

Practice address
614 MULLINS COLONY DR, EVANS, GA 30809-0579
(706) 760-7272
(706) 760-7276
Mailing address
4313 SOUTHERN PINES DR, EVANS, GA 30809-5147

Taxonomy

Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
207Q00000X
Family Medicine Physician
Primary
207QB0002X
Obesity Medicine (Family Medicine) Physician
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
261QH0100X
Health Service Clinic/Center
261QI0500X
Infusion Therapy Clinic/Center
305S00000X
Point of Service
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Enumeration date
08/18/2023
Last updated
01/19/2024
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