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General NPI Number Information
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NPI Number | 1386399285
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Entity Type | Organization
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Legal Business Name | SOZO WELLNESS CENTERS OF AMERICA LLC
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 100 BIDDLE AVE STE 204
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City | NEWARK
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State | DE
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Zip | 19702-3981
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Country | US
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Telephone | 678-296-0842
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Fax | 770-671-1951
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Provider Business Mailing Address
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Address Line | 2805 PEACHTREE INDUSTRIAL BLVD STE 213
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City | DULUTH
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State | GA
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Zip | 30097-8171
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Country | US
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Telephone | 678-296-0842
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Fax | 770-671-1951
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Authorized Official
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Title or Position | PMHNP
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Name | RONALD TYREE
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Credential |
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Telephone | 678-296-0842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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