Port-a-Wellness LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

042668 Issued in GA

Legal business name

PORT-A-WELLNESS LLC

Practice address

1670 Washington Ave
East Point, GA 30344-4248

Phone

(678) 705-1691

Fax

(855) 289-7475

NPI assigned

Mar 11, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ramona Ann Minnis, M..D.

Title

Medical Director

Phone

(678) 705-1691

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331424000000",
    "number": "1063787901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 WASHINGTON AVE",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303444248",
            "telephone_number": "678-705-1691",
            "fax_number": "855-289-7475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 WASHINGTON AVE",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303444248",
            "telephone_number": "678-705-1691",
            "fax_number": "855-289-7475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT-A-WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-11",
        "last_updated": "2012-03-11",
        "status": "A",
        "authorized_official_last_name": "MINNIS",
        "authorized_official_first_name": "RAMONA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "678-705-1691",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M..D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "042668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in East Point, GA
• Providers in East Point, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.