Organization
SOUTH FORSYTH WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH DIFABIO (CMO)
(770) 203-3998
Entity
Organization
Contact information
Practice address
6110 MCFARLAND STATION DR STE 1103, ALPHARETTA, GA 30004-6801
(770) 203-3998
Mailing address
411 JASMINE CT, CUMMING, GA 30040-7716
(770) 203-3998
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Enumeration date
02/18/2022
Last updated
02/18/2022
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