Organization
SISTAH SPACE WOMEN'S WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENEEN A LOMAX (OWNER)
(312) 451-7546
Entity
Organization
Contact information
Practice address
130 HOWELL RD, TYRONE, GA 30290-6800
(312) 451-7546
(470) 250-2401
Mailing address
351 LAUREN DR, FAIRBURN, GA 30213-7007
(312) 451-7546
(470) 250-2401
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
06/06/2019
Last updated
02/26/2020
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