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General NPI Number Information
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NPI Number | 1245962778
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Entity Type | Organization
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Legal Business Name | PEACHTREE WELLNESS SOLUTIONS LLC
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Dates
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Enumeration Date | 06/24/2022
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 100 GOVERNORS TRCE STE 110
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4853
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Country | US
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Telephone | 513-497-1982
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Fax |
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Provider Business Mailing Address
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Address Line | 116 PEACHTREE CT STE B
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4800
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Country | US
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Telephone | 513-497-1982
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JASON FLAIG
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Credential |
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Telephone | 513-497-1982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation 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 | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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