MEDICARE: WENDYS GARDEN PLANT GROW FLOURISH 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1619714383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WENDYS GARDEN PLANT GROW FLOURISH LLC

Provider Business Mailing Address
First Line	:	1870 THE EXCHANGE SE STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2021
Country	:	US
Telephone Number	:	407-792-1478
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 SAINT MICHAEL AVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-2549
Country	:	US
Telephone Number	:	804-300-9642
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHERRILLE GREENE
Credential	:	LCSW
Telephone Number	:	804-300-9642

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	07/10/2024

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