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General NPI Number Information
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NPI Number | 1407250814
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Entity Type | Organization
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Legal Business Name | JABEZ WELLNESS
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 122 RIVERSTONE COMMONS CIR
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City | CANTON
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State | GA
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Zip | 30114-5237
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Country | US
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Telephone | 813-758-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 122 RIVERSTONE COMMONS CIR
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City | CANTON
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State | GA
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Zip | 30114-5237
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Country | US
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Telephone | 813-758-5222
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURE PHYSICIAN
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Name | ANA MARIA VILLANUEVA
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Credential | DOM, AP
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Telephone | 813-758-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 314
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License Number State | GA
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