Healthcare Provider Details

I. General information

NPI: 1467388066
Provider Name (Legal Business Name): WELLSPRING PROPERTY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 OLIVER RD
FLOWERY BRANCH GA
30542-5223
US

IV. Provider business mailing address

379 FREEDOM PKWY
HOSCHTON GA
30548-1924
US

V. Phone/Fax

Practice location:
  • Phone: 470-381-1119
  • Fax:
Mailing address:
  • Phone: 470-381-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MATT BURCH
Title or Position: OWNER
Credential: LPC
Phone: 770-519-4154