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General NPI Number Information
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NPI Number | 1508358714
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Entity Type | Organization
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Legal Business Name | MBS WELLNESS GROUP, LLC
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 62 SHAWNEE TRAIL SE
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 904-563-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 4784 IVY RIDGE DRIVE SE
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City | ATLANTA
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State | GA
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Zip | 30339-1328
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Country | US
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Telephone | 904-563-0332
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PRESIDENT
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Name | MR. TOMMIE DOUGLAS BENEFIELD
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Credential |
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Telephone | 833-800-8327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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