NPIMap

Organization Active NPI

Wellness Life Center LLC

  • Family Medicine Physician
  • Cairo, GA
National Provider Identifier
1255815981
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WELLNESS LIFE CENTER LLC
Doing business as
Wellness Life Center, LLC
Practice address
1842 US Highway 84 W
Cairo, GA 39827-4224
Phone
(229) 377-2002
Fax
(229) 377-0930
NPI assigned
Sep 19, 2018
Last updated
Oct 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Authorized official

Name
Mrs. Laura M Odum, CPC
Title
Practice Manager
Phone
(229) 397-5433

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1842 US Highway 84 W
Cairo, GA 39827-4224

Mailing address

1842 US Highway 84 W
Cairo, GA 39827-4224
Phone (229) 397-5433

Other names 1

  • Wellness Life Center, LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181217001733 GA Part B Supplier - Clinic/Group Practice 1557606779 Receives reassigned benefits from 5 practitioners
Practice locations: Cairo, GA

National Provider Directory

National Provider Directory

Locations

1842 US Highway 84 W
Cairo, GA 39827
Phone (229) 377-2013

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FIAGBD

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1255815981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1842 US HIGHWAY 84 W",
            "city": "CAIRO",
            "state": "GA",
            "postal_code": "398274224",
            "telephone_number": "229-397-5433",
            "fax_number": "229-377-0930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1842 US HIGHWAY 84 W",
            "city": "CAIRO",
            "state": "GA",
            "postal_code": "398274224",
            "telephone_number": "229-377-2002",
            "fax_number": "229-377-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS LIFE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-19",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "ODUM",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "229-397-5433",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Life Center, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellness Life Center, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.