Provider Demographics
NPI:1043877962
Name:1 ON 1 STAFFING AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:1 ON 1 STAFFING AND WELLNESS CLINIC
Other - Org Name:ONE ON ONE STAFFING &WELLNESS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-669-0377
Mailing Address - Street 1:1315 DELAUNEY AVE STE 201-A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2367
Mailing Address - Country:US
Mailing Address - Phone:334-655-0315
Mailing Address - Fax:
Practice Address - Street 1:1315 DELAUNEY AVE STE 201-A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2367
Practice Address - Country:US
Practice Address - Phone:334-655-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-27
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty