| Organization Name: | ADVANCED WELLNESS CARE |
| NPI Number: | 1043620966 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LESLIE NICOLE FORTSON (MANAGER) |
| Mailing Address: | 151 S Houston Lake Rd Suite 110 Warner Robins |
| State: | GA US |
| Postal Code: | 310886399 |
| Phone Number: | 4783333026 |
| Fax Number: | 4787431516 |
| NPI Enumeration Date: | 04/30/2014 |
| NPI Last Update Date: | 10/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN190791 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |