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General NPI Number Information
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NPI Number | 1134988553
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Entity Type | Organization
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Legal Business Name | SACRED HEALING WELLNESS CENTER LLC
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 4652 LAWRENCEVILLE HWY NW STE 101
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City | LILBURN
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State | GA
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Zip | 30047-3623
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Country | US
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Telephone | 678-665-2046
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Fax | 470-567-5644
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Provider Business Mailing Address
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Address Line | 3870 PEACHTREE INDUSTRIAL BLVD STE 340
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City | DULUTH
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State | GA
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Zip | 30096-1474
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Country | US
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Telephone | 678-665-2046
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Fax | 470-567-5644
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA NADINE ALLEN
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Credential | FNP
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Telephone | 678-665-2046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health 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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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