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Organization

BALANCED ENERGY WELLNESS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. VIRGINIA RAWLS WHITTLESEY LAC (OWNER, LICENSED ACUPUNCTURIST)
(678) 871-9642
Entity
Organization

Contact information

Practice address
259 HIGHWAY 74 N STE 2, PEACHTREE CITY, GA 30269-3562
(678) 871-9642
Mailing address
457 CASTLEWOOD RD, TYRONE, GA 30290-2012
(678) 848-3319

Taxonomy

Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
353
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1063925832
NPI - TYPE 1
01
353
GEORGIA ACUPUNCTURE LICENSE #
GA
Enumeration date
01/08/2018
Last updated
01/08/2018
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