Provider Demographics
NPI:1336771237
Name:PRIMO WELLNESS
Entity type:Organization
Organization Name:PRIMO WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-235-3633
Mailing Address - Street 1:355 WELWYN WALK
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7058
Mailing Address - Country:US
Mailing Address - Phone:770-235-3633
Mailing Address - Fax:
Practice Address - Street 1:6742 JAMESTOWN DRIVE
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-3002
Practice Address - Country:US
Practice Address - Phone:770-235-3633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty