Provider Demographics
NPI:1093124059
Name:HANDS ON WELLNESS
Entity Type:Organization
Organization Name:HANDS ON WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-452-2955
Mailing Address - Street 1:3411 PIERCE DR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2411
Mailing Address - Country:US
Mailing Address - Phone:770-452-2955
Mailing Address - Fax:770-676-7237
Practice Address - Street 1:3411 PIERCE DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2411
Practice Address - Country:US
Practice Address - Phone:770-452-2955
Practice Address - Fax:770-676-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO009303302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization