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General NPI Number Information
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NPI Number | 1669252854
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Entity Type | Organization
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Legal Business Name | PRESERVATION WELLNESS CO.
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 109 CONSTITUTION DR STE 500
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8047
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Country | US
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Telephone | 404-683-9844
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 WATSON BLVD STE 1090
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3436
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Country | US
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Telephone | 404-683-9844
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISTY LANDOR
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Credential | NP
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Telephone | 404-683-9844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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