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General NPI Number Information
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NPI Number | 1255977435
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Entity Type | Organization
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Legal Business Name | PREMIER WELLNESS SOLUTIONS, LLC
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 1841 MONTREAL RD STE 110
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City | TUCKER
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State | GA
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Zip | 30084-5713
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Country | US
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Telephone | 404-735-0857
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Fax |
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Provider Business Mailing Address
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Address Line | 2716 BROOK PARK WAY
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City | DORAVILLE
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State | GA
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Zip | 30340-1810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND CLINIC DIRECTOR
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Name | MATTHEW UNDERWOOD
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Credential | DPT
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Telephone | 404-735-0857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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