Healthcare Provider Details

I. General information

NPI: 1598501942
Provider Name (Legal Business Name): WELGEN ONE OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 S FLORIDA AVE STE 3
LAKELAND FL
33813-1670
US

IV. Provider business mailing address

309 E PACES FERRY RD NE STE 400
ATLANTA GA
30305-2319
US

V. Phone/Fax

Practice location:
  • Phone: 770-212-0015
  • Fax:
Mailing address:
  • Phone: 770-212-0015
  • Fax: 866-820-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JODI MORGAN
Title or Position: VP OF OPERATIONS
Credential:
Phone: 502-830-3894