Healthcare Provider Details

I. General information

NPI: 1225283898
Provider Name (Legal Business Name): WELLNESS PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 PEACHTREE ST NE STE A01
ATLANTA GA
30303-1600
US

IV. Provider business mailing address

229 PEACHTREE ST NE STE A01
ATLANTA GA
30303-1600
US

V. Phone/Fax

Practice location:
  • Phone: 404-522-5552
  • Fax: 404-522-5151
Mailing address:
  • Phone: 404-522-5552
  • Fax: 404-522-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007312
License Number StateGA

VIII. Authorized Official

Name: MRS. INNA SAMANTHA TRAKHTENBERG
Title or Position: PRESIDENT
Credential: D.C.
Phone: 404-522-5552