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General NPI Number Information
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NPI Number | 1801151410
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Entity Type | Organization
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Legal Business Name | INTROSPEKTS WELLNESS GROUP
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 4300 PACES FERRY RD SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-5714
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Country | US
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Telephone | 770-948-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 PACES FERRY RD SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-5714
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Country | US
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Telephone | 770-948-8000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARYANN WILSON
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Credential |
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Telephone | 770-948-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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