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General NPI Number Information
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NPI Number | 1700743069
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Entity Type | Organization
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Legal Business Name | GRUV WELLNESS CLINIC
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 1240 SIGMAN RD NW STE 103
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City | CONYERS
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State | GA
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Zip | 30012-3934
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Country | US
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Telephone | 404-857-4788
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Fax | 404-335-7129
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Provider Business Mailing Address
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Address Line | 1240 SIGMAN RD NW STE 103
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City | CONYERS
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State | GA
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Zip | 30012-3934
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Country | US
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Telephone | 404-857-4788
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Fax | 404-335-7129
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA BANKS
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Credential | NP
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Telephone | 404-857-4788
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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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