Healthcare Provider Details

I. General information

NPI: 1548036908
Provider Name (Legal Business Name): WELLNESS & BEYOND MEDISPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 WHITTLESEY RD STE 400
COLUMBUS GA
31904-3657
US

IV. Provider business mailing address

1648 WHITTLESEY RD
COLUMBUS GA
31904-3658
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-1353
  • Fax: 706-221-1354
Mailing address:
  • Phone: 706-221-1353
  • Fax: 706-221-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MARGOLIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 706-221-1353