Healthcare Provider Details

I. General information

NPI: 1578397543
Provider Name (Legal Business Name): INSPIRE WELLNESS & AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 17TH ST NW UNIT 100
ATLANTA GA
30363-1205
US

IV. Provider business mailing address

270 17TH ST NW UNIT 100
ATLANTA GA
30363-1205
US

V. Phone/Fax

Practice location:
  • Phone: 404-282-4126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIBIBI WANZU
Title or Position: MANAGER
Credential:
Phone: 813-300-4449