Provider Demographics
NPI:1154927325
Name:INJURY & WELLNESS SPECIALISTS OF GEORGIA
Entity type:Organization
Organization Name:INJURY & WELLNESS SPECIALISTS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MODARESI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-800-1000
Mailing Address - Street 1:3800 HOLCOMB BRIDGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2230
Mailing Address - Country:US
Mailing Address - Phone:770-800-1000
Mailing Address - Fax:770-800-1000
Practice Address - Street 1:3800 HOLCOMB BRIDGE RD STE D
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2230
Practice Address - Country:US
Practice Address - Phone:770-800-1000
Practice Address - Fax:770-800-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty