Healthcare Provider Details

I. General information

NPI: 1982368585
Provider Name (Legal Business Name): LIQUID LIFE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 CAMDEN CT
ATLANTA GA
30349-8025
US

IV. Provider business mailing address

4938 ZOYA CT SW
ATLANTA GA
30331-7527
US

V. Phone/Fax

Practice location:
  • Phone: 404-729-5437
  • Fax:
Mailing address:
  • Phone: 404-729-5437
  • Fax: 404-745-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA ENJEMA
Title or Position: FNP
Credential: NP
Phone: 404-729-5437