NPIMap

Organization Active NPI

Angels of Grace Community Wellness Center, Inc.

  • Clinic/Center
  • Cairo, GA
National Provider Identifier
1154810844
Registry record updated Jun 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ANGELS OF GRACE COMMUNITY WELLNESS CENTER, INC.
Practice address
195 Martin Luther King Jr Ave SW
Cairo, GA 39828-2605
Phone
(229) 397-9355
NPI assigned
May 8, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2020

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

Authorized official

Name
Dr. Mary Weaver-Anderson, DRPH
Title
Ceo
Phone
(229) 397-9355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

195 Martin Luther King Jr Ave SW
Cairo, GA 39828-2605

Mailing address

PO Box 1510
Cairo, GA 39828-0970

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592006400000",
    "number": "1154810844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "CAIRO",
            "state": "GA",
            "postal_code": "398280970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 MARTIN LUTHER KING JR AVE SW",
            "city": "CAIRO",
            "state": "GA",
            "postal_code": "398282605",
            "telephone_number": "229-397-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELS OF GRACE COMMUNITY WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-08",
        "last_updated": "2020-06-13",
        "certification_date": "2020-06-13",
        "status": "A",
        "authorized_official_last_name": "WEAVER-ANDERSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-397-9355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DRPH"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cairo, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2020; 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.