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General NPI Number Information
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NPI Number | 1013809482
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Entity Type | Organization
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Legal Business Name | THE FRATERNITY MEN'S HEALTH AND WELLNESS
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 540 POWDER SPRINGS ST STE B8
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City | MARIETTA
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State | GA
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Zip | 30064-3560
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Country | US
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Telephone | 404-749-0571
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Fax | 949-864-3686
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Provider Business Mailing Address
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Address Line | 540 POWDER SPRINGS ST STE B8
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City | MARIETTA
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State | GA
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Zip | 30064-3560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MR. JOHN SIMUEL BEASLEY III
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Credential | NP
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Telephone | 404-749-0571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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