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General NPI Number Information
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NPI Number | 1487161766
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Entity Type | Organization
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Legal Business Name | BALANCED ENERGY WELLNESS, LLC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 259 HIGHWAY 74 N STE 2
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3562
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Country | US
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Telephone | 678-871-9642
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Fax |
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Provider Business Mailing Address
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Address Line | 457 CASTLEWOOD RD
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City | TYRONE
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State | GA
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Zip | 30290-2012
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Country | US
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Telephone | 678-848-3319
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Fax |
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Authorized Official
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Title or Position | OWNER, LICENSED ACUPUNCTURIST
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Name | MS. VIRGINIA RAWLS WHITTLESEY
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Credential | LAC
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Telephone | 678-871-9642
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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 | 353
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License Number State | GA
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