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General NPI Number Information
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NPI Number | 1013640242
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Entity Type | Organization
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Legal Business Name | LIVING WELL PRIMARY CARE, LLC
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 12460 CRABAPPLE RD STE 202-313
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City | ALPHARETTA
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State | GA
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Zip | 30004-6602
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Country | US
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Telephone | 404-819-7660
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Fax | 404-393-7788
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Provider Business Mailing Address
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Address Line | 12460 CRABAPPLE RD STE 202-313
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City | ALPHARETTA
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State | GA
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Zip | 30004-6602
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Country | US
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Telephone | 404-819-7660
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Fax | 404-393-7788
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | MRS. LEE PENNINGTON MCNICHOLS
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Credential | NP
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Telephone | 404-819-7660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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