Healthcare Provider Details

I. General information

NPI: 1992324453
Provider Name (Legal Business Name): D & G WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 SPICY CEDAR LN
LITHONIA GA
30038-7162
US

IV. Provider business mailing address

3236 SPICY CEDAR LN
LITHONIA GA
30038-7162
US

V. Phone/Fax

Practice location:
  • Phone: 404-780-3096
  • Fax: 678-669-2591
Mailing address:
  • Phone: 404-780-3096
  • Fax: 678-669-2591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE DUNBAR
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 404-780-3096