Organization
KIDNEY WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACIE WEAVER (CONTRACTING)
(937) 708-0881
Entity
Organization
Contact information
Practice address
5755 N POINT PKWY STE 267, ALPHARETTA, GA 30022-1175
(678) 373-8981
Mailing address
5755 N POINT PKWY STE 267, ALPHARETTA, GA 30022-1175
(678) 373-8981
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003207950C
—
GA
05
—
003207950D
—
GA
Enumeration date
10/08/2025
Last updated
02/03/2026
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