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NPI Code Detail

MEDICARE: THE INJURY WELLNESS INSTITUTE LLC

MEDICARE: THE INJURY WELLNESS INSTITUTE 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
1208VP0000XPain Medicine Physician

General Provider Information

NPI Number : 1679877898
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE INJURY WELLNESS INSTITUTE LLC
Provider Business Mailing Address
First Line : 2483 POWDER SPRINGS RD SW STE C
Second Line :
City : MARIETTA
State : GA
Zip : 30064-4573
Country : US
Telephone Number : 770-439-7575
Fax Number : 770-439-7550
Provider Business Practice Location Address
First Line : 2483 POWDER SPRINGS RD SW STE C
Second Line :
City : MARIETTA
State : GA
Zip : 30064-4573
Country : US
Telephone Number : 770-439-7575
Fax Number : 770-439-7550
Authorized Official
Title or Position : OWNER / FOUNDER
Name : LIONEL T JOHNSON
Credential :
Telephone Number : 770-439-7575
Provider Enumeration Date : 01/03/2011
Last Update Date : 01/03/2011

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Directions to “THE INJURY WELLNESS INSTITUTE LLC ” Practice Location

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