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Organization
LILAC WELLNESS AND SPA LLC
Active
Organization
LILAC WELLNESS AND SPA LLC
Active
Other names
Lilac Wellness and Spa
Organization subpart
No
Provider details
NPI number
Authorized official
LOLA OGUNNIYI (PRESIDENT)
(404) 725-8455
Entity
Organization
Contact information
Practice address
1841 MONTREAL RD STE 111, TUCKER, GA 30084-5712
(470) 871-9105
Mailing address
3050 FIVE FORKS TRICKUM RD SW STE D454, LILBURN, GA 30047-1810
(470) 871-9105
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
163WI0500X
Infusion Therapy Registered Nurse
—
NULL
163WI0500X
Infusion Therapy Registered Nurse
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
02/28/2024
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