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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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