Healthcare Provider Details

I. General information

NPI: 1679393888
Provider Name (Legal Business Name): COMPLETE HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 DAWSON RD
ALBANY GA
31707-3851
US

IV. Provider business mailing address

1201 DAWSON RD
ALBANY GA
31707-3851
US

V. Phone/Fax

Practice location:
  • Phone: 229-894-7877
  • Fax: 229-302-2086
Mailing address:
  • Phone: 229-894-7877
  • Fax: 229-302-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ZELDA PETERS
Title or Position: DIRECTOR
Credential: FNP, PMHNP
Phone: 229-894-7877