Organization
WELLPATH COMMUNITY CARE CENTERS OF NORTH CAROLINA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD CONYERS O'BRYAN MD (INCORPORATOR)
(843) 323-0833
Entity
Organization
Contact information
Practice address
755 HIGHLAND OAKS DR STE 204, WINSTON SALEM, NC 27103-7106
(336) 522-5235
Mailing address
1283 MURFREESBORO PIKE, NASHVILLE, TN 37217-2432
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
03/29/2021
Last updated
02/01/2022
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