Provider Demographics
NPI:1043963838
Name:SOLACE HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:SOLACE HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:423-227-8576
Mailing Address - Street 1:4605 CHESTNUT OAK ST
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-9408
Mailing Address - Country:US
Mailing Address - Phone:423-227-8576
Mailing Address - Fax:
Practice Address - Street 1:4605 CHESTNUT OAK ST
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-9408
Practice Address - Country:US
Practice Address - Phone:423-227-8576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251K00000XAgenciesPublic Health or Welfare