Provider Demographics
NPI:1972941276
Name:STOCKBRIDGE HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:STOCKBRIDGE HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-630-1582
Mailing Address - Street 1:175 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG 300C
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9054
Mailing Address - Country:US
Mailing Address - Phone:404-630-1582
Mailing Address - Fax:770-745-8797
Practice Address - Street 1:175 COUNTRY CLUB DR
Practice Address - Street 2:BLDG 300C
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9054
Practice Address - Country:US
Practice Address - Phone:404-630-1582
Practice Address - Fax:770-745-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty