Impact Wellness Center

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

GA050322 Issued in GA

Legal business name

IMPACT WELLNESS CENTER

Practice address

1989 N Williamsburg Dr
Suite E
Decatur, GA 30033-5998

Phone

(678) 717-9299

Fax

(404) 492-8885

NPI assigned

Mar 29, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Tefylon Cameron, DC

Title

Administrative Manager

Phone

(678) 717-9299

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1336671379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1989 N WILLIAMSBURG DR",
            "address_2": "SUITE E",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300335998",
            "telephone_number": "678-717-9299",
            "fax_number": "404-492-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1989 N WILLIAMSBURG DR",
            "address_2": "SUITE E",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300335998",
            "telephone_number": "678-717-9299",
            "fax_number": "404-492-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "CAMERON",
        "authorized_official_first_name": "TEFYLON",
        "authorized_official_title_or_position": "ADMINISTRATIVE MANAGER",
        "authorized_official_telephone_number": "678-717-9299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "GA",
            "license": "GA050322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine Physician in Decatur, GA
• Providers in Decatur, GA by specialty
• Pain Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; 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.