Provider Demographics
NPI:1043899941
Name:INDEPENDENT WELLNESS GROUP
Entity Type:Organization
Organization Name:INDEPENDENT WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-558-1794
Mailing Address - Street 1:10 GLENLAKE PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3495
Mailing Address - Country:US
Mailing Address - Phone:800-422-2346
Mailing Address - Fax:
Practice Address - Street 1:10 GLENLAKE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3495
Practice Address - Country:US
Practice Address - Phone:800-422-2346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No253Z00000XAgenciesIn Home Supportive Care