Healthcare Provider Details

I. General information

NPI: 1942575006
Provider Name (Legal Business Name): THE NILE WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 PRESIDENTIAL PKWY SUITE 106
ATLANTA GA
30340-3720
US

IV. Provider business mailing address

PO BOX 56147
ATLANTA GA
30343-0147
US

V. Phone/Fax

Practice location:
  • Phone: 770-454-1363
  • Fax:
Mailing address:
  • Phone: 770-454-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. DEBORAH BROOKS IMANI
Title or Position: CEO
Credential: COLON HYDROTHERAPIST
Phone: 404-932-9405