Healthcare Provider Details

I. General information

NPI: 1407764251
Provider Name (Legal Business Name): MEDICAL WELLNESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 EBENEZER RD SE
CONYERS GA
30094-2543
US

IV. Provider business mailing address

PO BOX 376
CONYERS GA
30012-0376
US

V. Phone/Fax

Practice location:
  • Phone: 404-939-7737
  • Fax:
Mailing address:
  • Phone: 404-939-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA W. CLEMENTS
Title or Position: CEO
Credential: RN
Phone: 470-717-7846