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General NPI Number Information
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NPI Number | 1255562757
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Entity Type | Organization
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Legal Business Name | WILLIAMS WELLNESS CENTER
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 2799 DELK RD SE SUITE 100
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City | MARIETTA
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State | GA
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Zip | 30067-6247
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Country | US
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Telephone | 770-955-2046
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Fax | 770-955-0993
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Provider Business Mailing Address
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Address Line | 2799 DELK RD SE SUITE 100
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City | MARIETTA
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State | GA
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Zip | 30067-6247
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Country | US
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Telephone | 770-955-2046
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Fax | 770-955-0993
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. REGINA WILLIAMS
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Credential |
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Telephone | 770-955-2046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 015440
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License Number State | GA
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