MEDICARE: INNOVATIVE HEALTH & WELLNESS BUCKHEAD

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1821484429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE HEALTH & WELLNESS BUCKHEAD

Provider Business Mailing Address
First Line	:	3115 PIEDMONT RD NE
Second Line	:	STE. 101-A
City	:	ATLANTA
State	:	GA
Zip	:	30305-2529
Country	:	US
Telephone Number	:	404-816-0222
Fax Number	:	404-464-7699

Provider Business Practice Location Address
First Line	:	3115 PIEDMONT RD NE
Second Line	:	STE. 101-A
City	:	ATLANTA
State	:	GA
Zip	:	30305-2529
Country	:	US
Telephone Number	:	404-816-0222
Fax Number	:	404-464-7699

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID M ORLANDO
Credential	:
Telephone Number	:	404-816-0222

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	04/20/2015

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