=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982066809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACUWELLNESS ATLANTA INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2016
-----------------------------------------------------
Last Update Date | 03/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 PHARR RD NE SUITE 410
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30305-3428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-841-9994
-----------------------------------------------------
Fax | 404-481-5128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 PHARR RD NE SUITE 410
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30305-3428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-841-9994
-----------------------------------------------------
Fax | 404-481-5128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LI LIU
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 404-841-9994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------