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Contact Information

EVERGREEN PRIMARY CARE AND WELLNESS PC
2450 ATLANTA HWY STE 803
CUMMING, GA30040-1252
 Phone: 470-253-7944
 Fax: 678-807-6144
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Family

363LF0000X 50 Nurse Practitioner
 

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for EVERGREEN PRIMARY CARE AND WELLNESS PC

NPI # 1285134999
LBN Legal business name EVERGREEN PRIMARY CARE AND WELLNESS PC
Authorized official HEATHER WANNER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/19/2018
Last updated 03/08/2018 - About 8 years ago
Identifiers
GA License # 52651
GA License # RN229572
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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