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Organization

PROFOUND WELLNESS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AREIGNA PRESTON OMT, LMT, BCTMB (OWNER/MANAGER)
(470) 323-6020
Entity
Organization

Contact information

Practice address
4855 RIVER GREEN PKWY STE 320, DULUTH, GA 30096-8337
(470) 323-7665
(877) 519-1412
Mailing address
3954 RIVERSTONE DR, SUWANEE, GA 30024-1894
(470) 573-7384
(877) 519-1412

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
225700000X
Massage Therapist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1467855924
GA
05
1922794676
GA
Enumeration date
04/14/2023
Last updated
11/23/2023
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