Wellpoint Medical Services, PC
Clinic/Center in Warner Robins, GA. Organization (NPI-2).
NPI number1114322575
StatusActive
Last updated in NPPESDec 29, 2014
Details
- NPI
- 1114322575
- Entity type
- Organization (NPI-2)
- Legal business name
- Wellpoint Medical Services, PC
- Organization subpart
- No
- Enumeration date
- Oct 28, 2014
- Last updated
- Dec 29, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | 051736 | GA | Yes |
Other names
- Wellpoint Medical Services, PC (Doing Business As)
Practice location
1533 Watson BlvdSte B
Warner Robins, GA 31093-3449
Phone 478-328-6466 · Fax 478-328-1338
Mailing address
1533 Watson BlvdSuite B
Warner Robins, GA 31093-3449
Phone 478-328-6466 · Fax 478-328-1338
Authorized official
Anthony T Securo
Medical Director
4783286466
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