Healthcare Provider Details

I. General information

NPI: 1780161323
Provider Name (Legal Business Name): PERSONAL WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 BOXWOOD TER
JOHNS CREEK GA
30005-7217
US

IV. Provider business mailing address

625 BOXWOOD TER
JOHNS CREEK GA
30005-7217
US

V. Phone/Fax

Practice location:
  • Phone: 770-569-9429
  • Fax:
Mailing address:
  • Phone: 770-569-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID ROBERT RICH
Title or Position: CEO
Credential:
Phone: 770-569-9429