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General NPI Number Information
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NPI Number | 1194332163
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Entity Type | Organization
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Legal Business Name | FIT WELLNESS LLC
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 3232 PEACHTREE RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-2407
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Country | US
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Telephone | 470-248-6172
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Fax |
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Provider Business Mailing Address
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Address Line | 3232 PEACHTREE RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-2407
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Country | US
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Telephone | 470-248-6172
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. GREG CHICKNEAS
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Credential |
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Telephone | 470-248-6172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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