Healthcare Provider Details

I. General information

NPI: 1598058257
Provider Name (Legal Business Name): EPWAVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 PEACHTREE RD NE SUITE 710
ATLANTA GA
30326-1026
US

IV. Provider business mailing address

PO BOX 94
CONYERS GA
30012-0094
US

V. Phone/Fax

Practice location:
  • Phone: 770-734-3876
  • Fax: 770-234-5103
Mailing address:
  • Phone: 770-734-3876
  • Fax: 770-234-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MISS LALISSIE MERGA
Title or Position: CEO
Credential: CNIM
Phone: 770-734-3876