Healthcare Provider Details

I. General information

NPI: 1700159126
Provider Name (Legal Business Name): LINK WELLNESS CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 N WILLIAMSBURG DR SUITE F
DECATUR GA
30033-5998
US

IV. Provider business mailing address

1989 N WILLIAMSBURG DR SUITE F
DECATUR GA
30033-5998
US

V. Phone/Fax

Practice location:
  • Phone: 404-325-1234
  • Fax: 404-325-5678
Mailing address:
  • Phone: 404-325-1234
  • Fax: 404-325-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. TEFYLON VELVETTE CAMERON
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 404-325-1234