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General NPI Number Information
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NPI Number | 1922539725
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Entity Type | Organization
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Legal Business Name | MPOWERR HEALTH & WELLNESS OF ATLANTA INC.
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 3616 GINNIS RD SW UNIT 2
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City | ATLANTA
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State | GA
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Zip | 30331-8574
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Country | US
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Telephone | 678-394-6584
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Fax |
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Provider Business Mailing Address
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Address Line | 3616 GINNIS RD SW UNIT 2
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City | ATLANTA
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State | GA
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Zip | 30331-8574
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Country | US
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Telephone | 678-394-6584
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TOURUS RONNARD JERELDS
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Credential | MPH
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Telephone | 678-394-6584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 17028051
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License Number State | GA
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