MEDICARE: SUMMIT WELLNESS GROUP WITH FLAIRE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20076174	OTHER	GA	PRIVATE FOR PROFIT

General Provider Information

NPI Number	:	1093338816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT WELLNESS GROUP WITH FLAIRE INC

Provider Business Mailing Address
First Line	:	745 HEMBREE PL
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4035
Country	:	US
Telephone Number	:	561-317-4563
Fax Number	:	770-299-1249

Provider Business Practice Location Address
First Line	:	996 HUFF RD NW STE C
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4333
Country	:	US
Telephone Number	:	770-299-1677
Fax Number	:	772-991-1249

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	MR. ROBERT SCHALIT III
Credential	:
Telephone Number	:	678-859-7244

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	01/25/2021

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