Basic Information
| Provider Information | |||||||||
| NPI: | 1043620966 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED WELLNESS CARE P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 BYRD WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783333026 | ||||||||
| FaxNumber: | 4782545102 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 BYRD WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783333026 | ||||||||
| FaxNumber: | 4782545102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | WARE | ||||||||
| AuthorizedOfficialFirstName: | ALTHEIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 7063150836 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | DNP, NP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN190791 | GA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | RN142278 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.