Organization
ANNUAL WELLNESS CENTERS OF AMERICA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER PENROD (BILLER)
(832) 289-9225
Entity
Organization
Contact information
Practice address
753 OLD NORCROSS RD STE B, LAWRENCEVILLE, GA 30046-4312
(770) 545-8888
Mailing address
5942 WATERSDOWN WAY, FLOWERY BRANCH, GA 30542-3221
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Enumeration date
05/15/2019
Last updated
05/15/2019
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