Healthcare Provider Details

I. General information

NPI: 1174277651
Provider Name (Legal Business Name): WOMB OF PEACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 E LAKE DR
MARIETTA GA
30062-2111
US

IV. Provider business mailing address

1634 E LAKE DR
MARIETTA GA
30062-2111
US

V. Phone/Fax

Practice location:
  • Phone: 678-510-3769
  • Fax:
Mailing address:
  • Phone: 678-510-3769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: YASMINE MARIE MINNIFIELD
Title or Position: CEO
Credential:
Phone: 678-510-3769