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General NPI Number Information
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NPI Number | 1114221264
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Entity Type | Organization
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Legal Business Name | DISCOVER HEALTH & WELLNESS SERVICES, LLC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 644 WELLS ST SW UNIT 5
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City | ATLANTA
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State | GA
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Zip | 30310-2066
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Country | US
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Telephone | 404-474-3211
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Fax | 678-528-5023
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Provider Business Mailing Address
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Address Line | 644 WELLS ST SW UNIT 5
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City | ATLANTA
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State | GA
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Zip | 30310-2066
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Country | US
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Telephone | 404-474-3211
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Fax | 678-528-5023
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | BRYAN M RUSSELL
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Credential | D.P.T.
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Telephone | 404-474-3211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PT8561
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT8561
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License Number State | GA
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