Organization
LUCENT INTEGRATIVE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. URSULA F. WALLER DNAP, CRNA (OWNER)
(706) 997-7266
Entity
Organization
Contact information
Practice address
1097 GREENSBORO RD STE 102, EATONTON, GA 31024-9510
(706) 997-7266
Mailing address
128 MARSHALL RD, BUCKHEAD, GA 30625-2906
(706) 997-7266
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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