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General NPI Number Information
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NPI Number | 1871399212
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Entity Type | Organization
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Legal Business Name | LODEBAR HEALTH AND WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 2945 STONE HOGAN CONNECTOR RD SW STE 205
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City | ATLANTA
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State | GA
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Zip | 30331-2839
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Country | US
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Telephone | 229-234-9695
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Fax |
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Provider Business Mailing Address
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Address Line | 2945 STONE HOGAN CONNECTOR RD SW STE 205
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City | ATLANTA
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State | GA
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Zip | 30331-2839
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Country | US
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Telephone | 404-343-1846
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | EMMANUELA C CONSEILLANT
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Credential | NP-BC
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Telephone | 229-234-9695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care 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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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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 | 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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