Provider Demographics
NPI:1316138811
Name:WELLNESSONE OF ALPHARETTA
Entity type:Organization
Organization Name:WELLNESSONE OF ALPHARETTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-850-0857
Mailing Address - Street 1:PO BOX 672553
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006-0043
Mailing Address - Country:US
Mailing Address - Phone:678-461-8877
Mailing Address - Fax:678-461-0087
Practice Address - Street 1:2850 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1660
Practice Address - Country:US
Practice Address - Phone:678-461-8877
Practice Address - Fax:678-461-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty