Active NPI
Wellness Medicine
- Family Medicine Physician
- Hampton, GA
National Provider Identifier
1417428129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- WELLNESS MEDICINE
- Practice address
- 990 Bear Creek Blvd Ste G
Hampton, GA 30228-1864 - Phone
- (678) 479-1234
- Fax
- (678) 479-5678
- NPI assigned
- Dec 7, 2018
- Organization subpart
- Yes
- Parent organization
- WELLNESS MEDICINE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jelunder Clark, MD
- Title
- Medical Director
- Phone
- (678) 479-1234
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
990 Bear Creek Blvd Ste G
Hampton, GA 30228-1864
Mailing address
990 Bear Creek Blvd Ste G
Hampton, GA 30228-1864
Phone (678) 479-1234
National Provider Directory
National Provider Directory- Part of
- Wellness Medicine
Locations
990 Bear Creek Blvd
Ste G
Hampton, GA 30228
Phone (678) 479-1234
Practitioners & affiliated clinicians
Practitioners 1
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": "1544140800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1544140800000",
"number": "1417428129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "990 BEAR CREEK BLVD STE G",
"city": "HAMPTON",
"state": "GA",
"postal_code": "302281864",
"telephone_number": "678-479-1234",
"fax_number": "678-479-5678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "990 BEAR CREEK BLVD STE G",
"city": "HAMPTON",
"state": "GA",
"postal_code": "302281864",
"telephone_number": "678-479-1234",
"fax_number": "678-479-5678"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLNESS MEDICINE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WELLNESS MEDICINE",
"enumeration_date": "2018-12-07",
"last_updated": "2018-12-07",
"status": "A",
"authorized_official_last_name": "CLARK",
"authorized_official_first_name": "JELUNDER",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "678-479-1234",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hampton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.