Provider Demographics
NPI:1417782376
Name:PRIME TREATMENT & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:PRIME TREATMENT & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OGOCHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:OJIAKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-457-3743
Mailing Address - Street 1:165 AVONLEA DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1226
Mailing Address - Country:US
Mailing Address - Phone:678-235-8934
Mailing Address - Fax:
Practice Address - Street 1:165 AVONLEA DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1226
Practice Address - Country:US
Practice Address - Phone:678-235-8934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty