Healthcare Provider Details

I. General information

NPI: 1114221264
Provider Name (Legal Business Name): DISCOVER HEALTH & WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 WELLS ST SW UNIT 5
ATLANTA GA
30310-2066
US

IV. Provider business mailing address

644 WELLS ST SW UNIT 5
ATLANTA GA
30310-2066
US

V. Phone/Fax

Practice location:
  • Phone: 404-474-3211
  • Fax: 678-528-5023
Mailing address:
  • Phone: 404-474-3211
  • Fax: 678-528-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT8561
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPT8561
License Number StateGA

VIII. Authorized Official

Name: BRYAN M RUSSELL
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: D.P.T.
Phone: 404-474-3211