Provider Demographics
NPI:1427244250
Name:ALPHEUS WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:ALPHEUS WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-213-3319
Mailing Address - Street 1:445 WINDY HILL RD SE STE 122
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7342
Mailing Address - Country:US
Mailing Address - Phone:678-213-3319
Mailing Address - Fax:678-213-3320
Practice Address - Street 1:445 WINDY HILL RD SE STE 122
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7342
Practice Address - Country:US
Practice Address - Phone:678-213-3319
Practice Address - Fax:678-213-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty