Organization
MEDIWELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FANNIE CLARK (CEO-DIRECTOR)
(678) 531-9692
Entity
Organization
Contact information
Practice address
2227 IDLEWOOD RD, SUITE 200, TUCKER, GA 30084-4827
(678) 531-9692
Mailing address
2227 IDLEWOOD RD, SUITE 200, TUCKER, GA 30084-4827
(678) 531-9692
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
Primary
—
—
Other
Enumeration date
09/28/2009
Last updated
09/28/2009
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