Organization
WELGEN ONE OF GEORGIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANIRA DELACRUZ (PRESIDENT)
(201) 233-2155
Entity
Organization
Contact information
Practice address
5415 SUGARLOAF PKWY STE 1108, LAWRENCEVILLE, GA 30043-7832
(833) 935-4361
Mailing address
629 S 4TH ST STE 301, LOUISVILLE, KY 40202-2461
(201) 233-2155
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
246YR1600X
Registered Record Administrator
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/10/2022
Last updated
11/08/2022
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