Provider Demographics
NPI:1366079998
Name:CLINIC ON WHEELS, PLLC
Entity type:Organization
Organization Name:CLINIC ON WHEELS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DEEMS
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:404-518-9760
Mailing Address - Street 1:30 PEACHTREE ST STE B
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-2940
Mailing Address - Country:US
Mailing Address - Phone:828-321-8035
Mailing Address - Fax:515-478-7299
Practice Address - Street 1:30 PEACHTREE ST STE B
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-2940
Practice Address - Country:US
Practice Address - Phone:828-321-8035
Practice Address - Fax:515-478-7299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINIC ON WHEELS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMW4793091OtherDEA