Provider Demographics
NPI:1285314088
Name:464 WELLNESS SOLUTIONS LLC
Entity type:Organization
Organization Name:464 WELLNESS SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:706-207-5860
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:31738-0822
Mailing Address - Country:US
Mailing Address - Phone:706-916-7716
Mailing Address - Fax:
Practice Address - Street 1:3184 TURMAN RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:GA
Practice Address - Zip Code:39846-7407
Practice Address - Country:US
Practice Address - Phone:706-916-7716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty