Provider Demographics
NPI:1316671290
Name:HOLISTIC ESSENTIAL WELLNESS LLC
Entity type:Organization
Organization Name:HOLISTIC ESSENTIAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FATANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-505-1069
Mailing Address - Street 1:5415 SUGARLOAF PKWY STE 1108
Mailing Address - Street 2:#5853
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5415 SUGARLOAF PKWY STE 1108
Practice Address - Street 2:#5853
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043
Practice Address - Country:US
Practice Address - Phone:678-505-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service