Provider Demographics
NPI:1982368585
Name:LIQUID LIFE WELLNESS
Entity type:Organization
Organization Name:LIQUID LIFE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENJEMA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:404-729-5437
Mailing Address - Street 1:4938 ZOYA CT SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7527
Mailing Address - Country:US
Mailing Address - Phone:404-729-5437
Mailing Address - Fax:404-745-8399
Practice Address - Street 1:3201 CAMDEN CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8025
Practice Address - Country:US
Practice Address - Phone:404-729-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care