Provider Demographics
NPI:1073127122
Name:WELLIFE CENTER LTD
Entity Type:Organization
Organization Name:WELLIFE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-404-5680
Mailing Address - Street 1:1117 PERIMETER CTR STE N316
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5443
Mailing Address - Country:US
Mailing Address - Phone:678-404-5680
Mailing Address - Fax:833-904-0122
Practice Address - Street 1:1117 PERIMETER CTR STE N316
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5443
Practice Address - Country:US
Practice Address - Phone:678-404-5680
Practice Address - Fax:833-904-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty