Healthcare Provider Details

I. General information

NPI: 1619126166
Provider Name (Legal Business Name): NATURAL WELLNESS CENTER OF ELLIJAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTH AVE STE 1
ELLIJAY GA
30540-3565
US

IV. Provider business mailing address

29 NORTH AVE STE 1
ELLIJAY GA
30540-3565
US

V. Phone/Fax

Practice location:
  • Phone: 706-698-4002
  • Fax: 706-698-4005
Mailing address:
  • Phone: 706-698-4002
  • Fax: 706-698-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007764
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT001421
License Number StateGA

VIII. Authorized Official

Name: JENNIFER HOULE
Title or Position: OWNER
Credential: LMT
Phone: 706-698-4002