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General NPI Number Information
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NPI Number | 1093524175
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Entity Type | Organization
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Legal Business Name | PURE ESSENCE WELLNESS
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 1800 JONESBORO RD SE
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City | ATLANTA
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State | GA
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Zip | 30315-5314
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Country | US
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Telephone | 404-805-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 5681 WINCHESTER PL
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City | STONECREST
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State | GA
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Zip | 30038-4084
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Country | US
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Telephone | 404-805-2444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SURAYYA ABDULMATEEN
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Credential | REGISTERED NURSE
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Telephone | 404-805-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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