Healthcare Provider Details

I. General information

NPI: 1942849708
Provider Name (Legal Business Name): WDM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PEACHFORD RD STE A
ATLANTA GA
30338-6521
US

IV. Provider business mailing address

2150 PEACHFORD RD STE A
ATLANTA GA
30338-6521
US

V. Phone/Fax

Practice location:
  • Phone: 770-674-0553
  • Fax:
Mailing address:
  • Phone: 770-674-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: WENDY D BARNES-MELLSTROM
Title or Position: OWNER
Credential: NP
Phone: 770-330-8001