Healthcare Provider Details

I. General information

NPI: 1871402941
Provider Name (Legal Business Name): WALKS OF LIFE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 PACES FERRY RD SE STE 500
ATLANTA GA
30339-5714
US

IV. Provider business mailing address

830 GLENWOOD AVE SE STE 510-251
ATLANTA GA
30316-1966
US

V. Phone/Fax

Practice location:
  • Phone: 470-210-4553
  • Fax: 470-275-0873
Mailing address:
  • Phone: 404-933-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JASMINE HENRY
Title or Position: OWNER
Credential: FNP
Phone: 407-933-2238