Provider Demographics
NPI:1023540465
Name:SB WELLNESS GROUP
Entity Type:Organization
Organization Name:SB WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-445-5814
Mailing Address - Street 1:520 SHADY LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4324
Mailing Address - Country:US
Mailing Address - Phone:225-445-5814
Mailing Address - Fax:
Practice Address - Street 1:520 SHADY LAKE PKWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-4324
Practice Address - Country:US
Practice Address - Phone:225-445-5814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19D0991695291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory