Healthcare Provider Details

I. General information

NPI: 1750059614
Provider Name (Legal Business Name): EXPLORE HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 LOWER ROSWELL RD STE 20
MARIETTA GA
30068-4385
US

IV. Provider business mailing address

4880 LOWER ROSWELL RD STE 20
MARIETTA GA
30068-4385
US

V. Phone/Fax

Practice location:
  • Phone: 470-381-1787
  • Fax:
Mailing address:
  • Phone: 470-381-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL RUITENBEEK
Title or Position: OWNER
Credential:
Phone: 404-901-2908