Healthcare Provider Details

I. General information

NPI: 1518286913
Provider Name (Legal Business Name): GEORGIA HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 HOWELL MILL ROAD SUITE 304
ATLANTA GA
30326
US

IV. Provider business mailing address

3280 HOWELL MILL ROAD SUITE 304
ATLANTA GA
30326
US

V. Phone/Fax

Practice location:
  • Phone: 404-941-2690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIM BURBARY
Title or Position: PRACITCE OWNER/ADMINISTRATOR
Credential:
Phone: 248-379-4560