Thelwell Immediate Care Clinic INC

NPI #1083256804 in Mableton, Georgia

Provider Information

NPI Number: 1083256804
Entity Type: Organization
Organization Name: Thelwell Immediate Care Clinic INC
Primary Specialty: Clinic/Center - Urgent Care
Enumeration Date: Oct 14, 2019
Last Updated: Oct 14, 2019

Practice Location

Address: 1400 VETERANS MEMORIAL HIGHWAY SE SUITE 134 #176
City: Mableton
State: Georgia
ZIP Code: 30126
Phone: (646) 402-1122

Authorized Official

Name: ENOMA EVBUOMWAN, PA-C
Title: PHYSICIAN ASSISTANT
Phone: (646) 402-1122

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Health Service — Health Service	261QH0100X
Clinic/Center - Primary Care — Primary Care	261QP2300X
Clinic/Center - VA — VA	261QV0200X
Physician Assistant - Medical — Medical	363AM0700X
Nurse Practitioner - Family — Family	363LF0000X
Clinic/Center - Rural Health — Rural Health	261QR1300X
Clinic/Center - Urgent Care — Urgent Care	261QU0200X	Primary

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