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General NPI Number Information
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NPI Number | 1891243184
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Entity Type | Organization
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Legal Business Name | ELITE NATURAL WELLNESS
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 528 SUNNYLAND DR
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City | THOMASTON
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State | GA
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Zip | 30286-2433
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Country | US
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Telephone | 404-430-3240
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Fax |
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Provider Business Mailing Address
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Address Line | 107 YATESVILLE RD
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City | BARNESVILLE
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State | GA
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Zip | 30204-3788
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHERRAL T HUDSON
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Credential | NP
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Telephone | 404-430-3240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | CA
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