Organization
WELLSPRING FAMILY MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. OLUBUNMI A AYENI REGISTERED NURSE (OFFICE MANAGER)
(678) 289-8338
Entity
Organization
Contact information
Practice address
2759 MOUNT ZION PKWY, SUITE 3, JONESBORO, GA 30236-2568
(678) 289-8338
(770) 603-0515
Mailing address
2759 MOUNT ZION PKWY STE C, JONESBORO, GA 30236-2568
(678) 289-8338
(770) 603-0515
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
43534
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00794857C
—
GA
05
—
00794857D
—
GA
Enumeration date
03/13/2012
Last updated
03/12/2020
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