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General NPI Number Information
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NPI Number | 1316206055
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Entity Type | Organization
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Legal Business Name | WELLNESS LEARNING CENTER INC
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 09/25/2021
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Provider Practice Location Address
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Address Line | 455 E PACES FERRY RD NE SUITE 201
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City | ATLANTA
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State | GA
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Zip | 30305-3313
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Country | US
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Telephone | 404-233-0208
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Fax |
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Provider Business Mailing Address
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Address Line | 455 E PACES FERRY RD NE SUITE 201
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City | ATLANTA
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State | GA
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Zip | 30305-3313
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Country | US
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Telephone | 404-233-0208
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. HENRY JACOBS
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Credential | D.C.
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Telephone | 404-266-0208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHIR005327
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License Number State | GA
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