MEDICARE: WELLNESS ONE MARIETTA

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	111N00000X	Chiropractor	GA6328	GA
2	111N00000X	Chiropractor	GA5936	GA
3	207Q00000X	Family Medicine Physician	024767	GA

General Provider Information

NPI Number	:	1447474689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS ONE MARIETTA

Provider Business Mailing Address
First Line	:	PO BOX 672542
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30006-2542
Country	:	US
Telephone Number	:	770-795-0506
Fax Number	:	770-795-0392

Provider Business Practice Location Address
First Line	:	2727 CANTON ROAD
Second Line	:	SUITE # 520
City	:	MARIETTA
State	:	GA
Zip	:	30066
Country	:	US
Telephone Number	:	770-795-0506
Fax Number	:	770-795-0392

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. DANIEL LYNN MIDDLETON
Credential	:
Telephone Number	:	770-850-0857

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	09/11/2025

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Directions to “WELLNESS ONE MARIETTA ” Practice Location

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