Healthcare Provider Details

I. General information

NPI: 1619631355
Provider Name (Legal Business Name): JOINT HEALTH AND WELLNESS OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W COLLEGE ST STE C
GRIFFIN GA
30224-4249
US

IV. Provider business mailing address

230 W COLLEGE ST STE C
GRIFFIN GA
30224-4249
US

V. Phone/Fax

Practice location:
  • Phone: 678-871-3735
  • Fax:
Mailing address:
  • Phone: 678-871-3735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DEREK SHAHN HALL
Title or Position: MANAGING MEMBER
Credential:
Phone: 404-734-8139