Healthcare Provider Details

I. General information

NPI: 1639484975
Provider Name (Legal Business Name): HEALTH AND WEALTH CENTERS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BANKS STA
FAYETTEVILLE GA
30214-7505
US

IV. Provider business mailing address

215 BANKS STA
FAYETTEVILLE GA
30214-7505
US

V. Phone/Fax

Practice location:
  • Phone: 770-719-4949
  • Fax: 770-719-4661
Mailing address:
  • Phone: 770-719-4949
  • Fax: 770-719-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LISA BUNN
Title or Position: ADMINISTRATOR
Credential:
Phone: 770-719-4949