Provider Demographics
NPI:1306335203
Name:EPIC WELLCARE, LLC
Entity type:Organization
Organization Name:EPIC WELLCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBYSINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-855-3339
Mailing Address - Street 1:4036 STEPHENS MILL RUN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3882
Mailing Address - Country:US
Mailing Address - Phone:404-855-3339
Mailing Address - Fax:404-255-2170
Practice Address - Street 1:1989 N WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5998
Practice Address - Country:US
Practice Address - Phone:404-855-3339
Practice Address - Fax:404-255-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029684207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty