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General NPI Number Information
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NPI Number | 1760145122
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Entity Type | Organization
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Legal Business Name | INDEPENDENTLY HEALTHY WELLNESS & COACHING LLC
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 5690 HENDRIX RD
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City | CUMMING
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State | GA
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Zip | 30040-3832
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Country | US
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Telephone | 470-344-3934
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Fax |
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Provider Business Mailing Address
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Address Line | 5690 HENDRIX RD
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City | CUMMING
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State | GA
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Zip | 30040-3832
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Country | US
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Telephone | 470-344-3934
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Fax |
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Authorized Official
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Title or Position | CEO AND OWNER
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Name | DR. ANNA KOLOMITSEVA
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Credential |
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Telephone | 678-787-9142
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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 |
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License Number State |
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