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General NPI Number Information
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NPI Number | 1235786419
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Entity Type | Organization
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Legal Business Name | PREVENTATIVE HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 2310 HENRY CLOWER BLVD STE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-5776
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Country | US
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Telephone | 347-559-3139
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Fax | 800-364-0927
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Provider Business Mailing Address
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Address Line | 2310 HENRY CLOWER BLVD STE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-5776
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Country | US
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Telephone | 347-559-3139
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Fax | 800-364-0927
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSE R ALLEN
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Credential |
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Telephone | 347-559-3139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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