MEDICARE: ADVANCED PRACTICE HEALTH AND WELLNESS

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1851068134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PRACTICE HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	3800 CAMP CREEK PKWY SW BLDG 1400-116
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-6045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 CAMP CREEK PKWY SW BLDG 1400-116
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-6045
Country	:	US
Telephone Number	:	229-296-4502
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	ENIKA MCCLAIN
Credential	:
Telephone Number	:	229-296-4502

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/25/2021

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