Healthcare Provider Details

I. General information

NPI: 1780337337
Provider Name (Legal Business Name): NORCROSS WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 HOLCOMB BRIDGE RD STE 215
PEACHTREE CORNERS GA
30092-5219
US

IV. Provider business mailing address

3850 HOLCOMB BRIDGE RD STE 215
PEACHTREE CORNERS GA
30092-5219
US

V. Phone/Fax

Practice location:
  • Phone: 704-305-1430
  • Fax: 770-637-5377
Mailing address:
  • Phone:
  • Fax: 770-637-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN HEILIG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 704-305-1430