=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538491782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE HUNDRED PERCENT HEALTH AND WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2010
-----------------------------------------------------
Last Update Date | 02/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1046 DAVIS CIR NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-7525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-290-4248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1046 DAVIS CIR NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-7525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PRESIDENT, AND CEO
-----------------------------------------------------
Name | DR. STEVEN DAVID ROFFERS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 404-290-4248
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | CHIR008570
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------