MEDICARE: ALLIED WELLNESS LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1508612425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED WELLNESS LLC

Provider Business Mailing Address
First Line	:	5579 CHAMBLEE DUNWOODY RD STE B
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-4100
Country	:	US
Telephone Number	:	678-478-8812
Fax Number	:

Provider Business Practice Location Address
First Line	:	5579 CHAMBLEE DUNWOODY RD STE B
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-4100
Country	:	US
Telephone Number	:	678-478-8812
Fax Number	:

Authorized Official
Title or Position	:	LPC
Name	:	BRIAN CUNNINGHAM
Credential	:
Telephone Number	:	678-478-8812

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	05/14/2024

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Directions to “ALLIED WELLNESS LLC ” Practice Location

Language	Start Address	Practice Location

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