MEDICARE: CAVA WELLNESS TELEHEALTH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist
3	2084P0800X	Psychiatry Physician
4	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1912770017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAVA WELLNESS TELEHEALTH INC.

Provider Business Mailing Address
First Line	:	8735 DUNWOODY PL # 4867
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8735 DUNWOODY PL # 4867
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	770-268-2539
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JIMMY-SHAROD TATE
Credential	:
Telephone Number	:	678-927-4710

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	12/21/2023

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