Healthcare Provider Details

I. General information

NPI: 1508358714
Provider Name (Legal Business Name): MBS WELLNESS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 SHAWNEE TRAIL SE
MARIETTA GA
30067
US

IV. Provider business mailing address

4784 IVY RIDGE DRIVE SE
ATLANTA GA
30339-1328
US

V. Phone/Fax

Practice location:
  • Phone: 904-563-0332
  • Fax:
Mailing address:
  • Phone: 904-563-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. TOMMIE DOUGLAS BENEFIELD
Title or Position: FOUNDER/PRESIDENT
Credential:
Phone: 833-800-8327