Organization Active NPI

Wellspring

  • Mental Health Counselor
  • Gainesville, FL
National Provider Identifier
1558765016
Registry record updated Oct 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
ME0037298 Issued in FL
Legal business name
WELLSPRING
Practice address
5618 NW 43Rd St
Gainesville, FL 32653-3406
Phone
(352) 377-8770
Fax
(352) 371-3623
NPI assigned
Oct 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2014

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

Authorized official

Name
Dr. George Randall Williams, MD
Title
Owner
Phone
(352) 377-8770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X ME0037298 FL Primary

Addresses

Primary practice location

5618 NW 43Rd St
Gainesville, FL 32653-3406

Mailing address

5618 NW 43Rd St
Gainesville, FL 32653-3406
Phone (352) 377-8770

Other identifiers 1

IdentifierTypeStateIssuer
59 3213731OtherFLPSYCHIATRY

National Provider Directory

National Provider Directory

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": "1413158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1558765016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5618 NW 43RD ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326533406",
            "telephone_number": "352-377-8770",
            "fax_number": "352-371-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5618 NW 43RD ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326533406",
            "telephone_number": "352-377-8770",
            "fax_number": "352-371-3623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-13",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "RANDALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-377-8770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "ME0037298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHIATRY",
            "identifier": "59 3213731",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; 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.