Organization
LILAC WELLNESS AND SPA LLC
Active
Other names
Lilac Wellness and Spa
Organization subpart
No
Provider details
NPI number
Authorized official
LOLA OGUNNIYI (PRESIDENT)
(404) 725-8455
Entity
Organization
Contact information
Practice address
1841 MONTREAL RD STE 111, TUCKER, GA 30084-5712
(470) 871-9105
Mailing address
3050 FIVE FORKS TRICKUM RD SW STE D454, LILBURN, GA 30047-1810
(470) 871-9105
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
163WI0500X
Infusion Therapy Registered Nurse
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
02/28/2024
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