Healthcare Provider Details

I. General information

NPI: 1841784147
Provider Name (Legal Business Name): ATLANTA WEIGHT LOSS & WELLNESS ASSOCIATES, LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 PEACHTREE RD NE STE 555
ATLANTA GA
30326-1418
US

IV. Provider business mailing address

173 JANS MDWS
STOCKBRIDGE GA
30281-5855
US

V. Phone/Fax

Practice location:
  • Phone: 678-289-0006
  • Fax:
Mailing address:
  • Phone: 404-988-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN130943
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number StateGA

VIII. Authorized Official

Name: SABRINA M LEE
Title or Position: OWNER/DIRECTOR OF NURSING
Credential: RN
Phone: 404-988-0265