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General NPI Number Information
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NPI Number | 1346307048
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Entity Type | Organization
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Legal Business Name | EAST METRO WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1289 PARKER RD SE
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City | CONYERS
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State | GA
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Zip | 30094-5957
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Country | US
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Telephone | 770-922-7282
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Fax | 770-922-7843
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Provider Business Mailing Address
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Address Line | PO BOX 83363
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City | CONYERS
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State | GA
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Zip | 30013-9444
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Country | US
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Telephone | 770-922-7282
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Fax | 770-922-7843
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CORNELIUS STEPHENS
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Credential | D.C.
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Telephone | 770-922-7282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 002911
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License Number State | GA
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