Organization
MIND BODY SPIRIT WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAIYSHA TANIA CLAIRBORNE MD (PRESIDENT/CEO)
(404) 478-9868
Entity
Organization
Contact information
Practice address
2801 BUFORD HWY NE STE T65, ATLANTA, GA 30329-2145
(404) 478-9868
Mailing address
2484 BRIARCLIFF RD NE STE 22-315, ATLANTA, GA 30329-3011
(404) 478-9868
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
055194
GA
261QP2300X
Primary Care Clinic/Center
055194
GA
Other
Enumeration date
02/06/2012
Last updated
02/06/2012
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