Healthcare Provider Details

I. General information

NPI: 1942922190
Provider Name (Legal Business Name): RESOLUTION NATURAL-WELLNESS & CONCIERGE SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13165 BROWN BRIDGE RD
COVINGTON GA
30016-4115
US

IV. Provider business mailing address

101 N 8TH ST UNIT 2231
GRIFFIN GA
30223-3011
US

V. Phone/Fax

Practice location:
  • Phone: 678-774-9156
  • Fax:
Mailing address:
  • Phone: 678-774-9156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TEEISA RICHARDSON
Title or Position: CEO
Credential: FNP-C
Phone: 678-774-9156