Healthcare Provider Details

I. General information

NPI: 1962368555
Provider Name (Legal Business Name): DWF WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13165 BROWN BRIDGE RD
COVINGTON GA
30016-4115
US

IV. Provider business mailing address

13165 BROWN BRIDGE RD
COVINGTON GA
30016-4115
US

V. Phone/Fax

Practice location:
  • Phone: 678-532-9442
  • Fax:
Mailing address:
  • Phone: 678-532-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name: DAWN ALICIA WELLS
Title or Position: OWNER
Credential: CEP
Phone: 678-532-9442