Organization
PATHWAY TO WELLNESS CENTER PC
Active
Organization
PATHWAY TO WELLNESS CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IMO F NDEM M.D,M.P.H (MEDICAL DIRECTOR/PHYSICIAN)
(706) 228-2929
Entity
Organization
Contact information
Practice address
4111 OLD PETERSBURG RD, 4111 OLD PETERSBURG RD, MARTINEZ, GA 30907-3346
(706) 228-2929
Mailing address
4111 OLD PETERSBURG RD, 4111 OLD PETERSBURG RD, MARTINEZ, GA 30907-3346
(706) 228-2929
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
060968
GA
2083X0100X
Occupational Medicine Physician
060968
GA
Other
Enumeration date
04/16/2012
Last updated
04/16/2012
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