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General NPI Number Information
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NPI Number | 1679111454
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Entity Type | Organization
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Legal Business Name | PRE WELLNESS CARE ATLANTA
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 2001 MARTIN LUTHER KING JR DR SW
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City | ATLANTA
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State | GA
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Zip | 30310-1101
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Country | US
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Telephone | 404-691-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 MARTIN LUTHER KING JR DR SW
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City | ATLANTA
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State | GA
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Zip | 30310-1101
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Country | US
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Telephone | 404-691-3344
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ELIJUA WATSON
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Credential |
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Telephone | 414-238-4596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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