Organization
EVERGREEN PRIMARY CARE AND WELLNESS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HEATHER B WANNER NP-C (OWNER)
(470) 253-7944
Entity
Organization
Contact information
Practice address
2450 ATLANTA HWY STE 803, CUMMING, GA 30040-1252
(470) 253-7944
(678) 807-6144
Mailing address
5485 BETHELVIEW RD STE 360-331, CUMMING, GA 30040-9735
(470) 253-7944
(678) 807-6144
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
RN229572
GA
207R00000X
Internal Medicine Physician
Primary
52651
GA
363LF0000X
Family Nurse Practitioner
RN229572
GA
Other
Enumeration date
02/19/2018
Last updated
03/08/2018
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