Provider Demographics
NPI:1720703655
Name:BLESSED HANDS WELLNESS SPA LLC
Entity type:Organization
Organization Name:BLESSED HANDS WELLNESS SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHNITA
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:706-399-9624
Mailing Address - Street 1:4404 COLUMBIA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4553
Mailing Address - Country:US
Mailing Address - Phone:706-399-9624
Mailing Address - Fax:
Practice Address - Street 1:4404 COLUMBIA RD STE 106
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4553
Practice Address - Country:US
Practice Address - Phone:706-399-9624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service