Organization
PALMETTO HEALTH COUNCIL INC
Active
Other names
Community Medical Center, YourTown Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON WILLIAM WOLLENZIEN JR. DBA (CHIEF EXECUTIVE OFFICER)
(404) 929-8824
Entity
Organization
Contact information
Practice address
643 MAIN ST, PALMETTO, GA 30268-1138
(404) 929-8824
(404) 929-9769
Mailing address
643 MAIN ST, PALMETTO, GA 30268-1138
(404) 929-8824
(404) 929-9769
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
H800040
GA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
H800040
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000228379A
—
GA
05
—
000472128A
—
GA
05
—
000472128E
—
GA
05
—
000472128F
—
GA
05
—
000472128G
—
GA
05
—
000472128H
—
GA
05
—
931512872A
—
GA
Enumeration date
09/29/2006
Last updated
09/10/2021
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