Organization
POSITIVE BALANCE WELLNESS CENTER @ BEN HILL UNITED METHODIST CHURCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA PATRICE SHANNON MD (DIRECTOR)
(404) 346-8264
Entity
Organization
Contact information
Practice address
2099 FAIRBURN RD SW, ATLANTA, GA 30331-4812
(404) 428-3133
(404) 344-7810
Mailing address
2099 FAIRBURN RD SW, ATLANTA, GA 30331-4812
(404) 428-3133
(404) 344-7810
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
036661
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000635115E
—
GA
05
—
00635115D
—
GA
01
—
1285707455
NPI
GA
01
—
2084P08000X
TAXONOMY
GA
Enumeration date
04/16/2015
Last updated
04/16/2015
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