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General NPI Number Information
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NPI Number | 1235576117
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Entity Type | Organization
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Legal Business Name | STAYHEALTHY WELLNESS GROUP
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 2818 NORMAN BERRY DR
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City | EAST POINT
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State | GA
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Zip | 30344-3500
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Country | US
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Telephone | 770-401-4748
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Fax |
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Provider Business Mailing Address
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Address Line | 2818 NORMAN BERRY DR
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City | EAST POINT
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State | GA
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Zip | 30344-3500
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Country | US
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Telephone | 770-401-4748
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JERRY MCGAUGHY
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Credential |
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Telephone | 770-401-4748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | GA
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