MEDICARE: INSPIRE WELLNESS & AESTHETICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202D00000X	Integrative Medicine Physician

General Provider Information

NPI Number	:	1578397543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRE WELLNESS & AESTHETICS, LLC

Provider Business Mailing Address
First Line	:	270 17TH ST NW UNIT 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30363-1205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 17TH ST NW UNIT 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30363-1205
Country	:	US
Telephone Number	:	404-282-4126
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KIBIBI WANZU
Credential	:
Telephone Number	:	813-300-4449

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	08/30/2024

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