Healthcare Provider Details

I. General information

NPI: 1255245379
Provider Name (Legal Business Name): WELLAXIS HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 STONE BLUFF DR
DOUGLASVILLE GA
30134-3776
US

IV. Provider business mailing address

7345 STONE BLUFF DR
DOUGLASVILLE GA
30134-3776
US

V. Phone/Fax

Practice location:
  • Phone: 678-755-3112
  • Fax:
Mailing address:
  • Phone: 678-755-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. IHEBUCHE MIRACLE OKORIE
Title or Position: AUTHORIZED AGENT
Credential: DBA
Phone: 678-755-3112