Provider Demographics
NPI:1306288048
Name:DUNWOODY HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:DUNWOODY HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILFORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-551-9616
Mailing Address - Street 1:1829 INDEPENDENCE SQ
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5153
Mailing Address - Country:US
Mailing Address - Phone:770-551-9616
Mailing Address - Fax:770-394-3647
Practice Address - Street 1:1829 INDEPENDENCE SQ
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5153
Practice Address - Country:US
Practice Address - Phone:770-551-9616
Practice Address - Fax:770-394-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0026933207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty