Healthcare Provider Details

I. General information

NPI: 1265361893
Provider Name (Legal Business Name): REBYRTH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 N WILLIAMSBURG DR STE I
DECATUR GA
30033-3509
US

IV. Provider business mailing address

1989 N WILLIAMSBURG DR STE I
DECATUR GA
30033-3509
US

V. Phone/Fax

Practice location:
  • Phone: 479-909-1226
  • Fax:
Mailing address:
  • Phone: 479-909-1226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: IMANI NICOLE BYERS-QUARTERMAN
Title or Position: OWNER
Credential: LCSW
Phone: 912-441-9922