| NPI | 1457512766 |
|---|---|
| Doing Business As | LAKESIDE WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | ALTHEA ANNETTE JOHNSON CEO 910-202-8623 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2023-11-09 |