Provider Demographics
NPI:1154924637
Name:AMCARE ENTERPRISES INC
Entity type:Organization
Organization Name:AMCARE ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-964-0611
Mailing Address - Street 1:284 HIGHWAY 314 STE E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7832
Mailing Address - Country:US
Mailing Address - Phone:770-964-0611
Mailing Address - Fax:770-964-0608
Practice Address - Street 1:284 HIGHWAY 314 STE E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7832
Practice Address - Country:US
Practice Address - Phone:770-964-0611
Practice Address - Fax:770-964-0608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMCARE ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000272379TMedicaid