Provider Demographics
NPI:1962693481
Name:WELLNESSONE OF BUCKHEAD
Entity type:Organization
Organization Name:WELLNESSONE OF BUCKHEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECOR
Authorized Official - Prefix:
Authorized Official - First Name:KEYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-850-0857
Mailing Address - Street 1:PO BOX 672351
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006-0040
Mailing Address - Country:US
Mailing Address - Phone:404-869-1973
Mailing Address - Fax:404-869-1976
Practice Address - Street 1:3165 PEACHTREE RD NE STE E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1851
Practice Address - Country:US
Practice Address - Phone:404-869-1973
Practice Address - Fax:404-869-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty