Organization
SHALLOWFORD WELLNESS CENTER LLC
Active
Organization
SHALLOWFORD WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOFIA KHAN (CEO)
(404) 435-6604
Entity
Organization
Contact information
Practice address
3300 NORTHEAST EXPY NE, ATLANTA, GA 30341-3932
(404) 435-6604
Mailing address
2521 OAK GROVE ESTS NE, ATLANTA, GA 30345-7601
Taxonomy
Speciality
Code
Description
License number
State
2084P0005X
Neurodevelopmental Disabilities Physician
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/19/2023
Last updated
08/04/2025
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