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General NPI Number Information
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NPI Number | 1487522546
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Entity Type | Organization
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Legal Business Name | EVOLUTIO WELLNESS LLC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 1325 ROCK QUARRY RD STE 100
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5029
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Country | US
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Telephone | 770-389-0566
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Fax |
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Provider Business Mailing Address
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Address Line | 160 GLEN EAGLE WAY
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City | MCDONOUGH
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State | GA
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Zip | 30253-4227
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Country | US
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Telephone | 770-910-6826
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELIQUE YOUNG
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Credential | FNP-C
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Telephone | 770-910-6826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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