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General NPI Number Information
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NPI Number | 1477869931
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Entity Type | Organization
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Legal Business Name | GEORGIA HEALTH & WELLNESS CORPORATION
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Dates
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Enumeration Date | 08/23/2010
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 3280 HOWELL MILL RD NW SUITE 304
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City | ATLANTA
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State | GA
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Zip | 30327-4111
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Country | US
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Telephone | 404-941-2690
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Fax | 404-941-2698
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Provider Business Mailing Address
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Address Line | 3280 HOWELL MILL RD NW SUITE 304
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City | ATLANTA
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State | GA
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Zip | 30327-4111
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Country | US
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Telephone | 404-941-2690
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Fax | 404-941-2698
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. TIMOHTY MICHAEL BURBARY
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Credential |
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Telephone | 404-941-2690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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