Provider Demographics
NPI:1114221264
Name:DISCOVER HEALTH & WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:DISCOVER HEALTH & WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:404-474-3211
Mailing Address - Street 1:644 WELLS ST SW UNIT 5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2066
Mailing Address - Country:US
Mailing Address - Phone:404-474-3211
Mailing Address - Fax:678-528-5023
Practice Address - Street 1:644 WELLS ST SW UNIT 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-2066
Practice Address - Country:US
Practice Address - Phone:404-474-3211
Practice Address - Fax:678-528-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT8561261QP2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies