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General NPI Number Information
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NPI Number | 1467991992
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Entity Type | Organization
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Legal Business Name | WELLSPINE LLC
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 3000 WINDY HILL RD #674591
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City | MARIETTA
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State | GA
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Zip | 30006
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Country | US
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Telephone | 404-913-6462
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 WINDY HILL RD #674591
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City | MARIETTA
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State | GA
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Zip | 30006
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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 | MANAGER
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Name | ASHIA RALLINGS
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Credential |
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Telephone | 19016494228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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