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General NPI Number Information
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NPI Number | 1689121766
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Entity Type | Organization
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Legal Business Name | ATLANTA WELLNESS STUDIO, LLC
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 2751 BUFORD HWY NE SUITE 700
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City | ATLANTA
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State | GA
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Zip | 30324-3207
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Country | US
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Telephone | 877-500-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 2751 BUFORD HWY NE SUITE 700
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City | ATLANTA
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State | GA
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Zip | 30324-3207
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Country | US
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Telephone | 877-500-0044
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | RICHARD WILLIAMS
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Credential | LMT, CNMT, C.HT.
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Telephone | 877-500-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | MT006947
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License Number State | GA
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