Provider Demographics
NPI:1396464335
Name:STAT WELLNESS
Entity type:Organization
Organization Name:STAT WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-254-5905
Mailing Address - Street 1:1465 HOWELL MILL RD NW STE 300A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4246
Mailing Address - Country:US
Mailing Address - Phone:404-254-5905
Mailing Address - Fax:
Practice Address - Street 1:1465 HOWELL MILL RD NW STE 300A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4246
Practice Address - Country:US
Practice Address - Phone:404-254-5905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center