Provider Demographics
NPI:1225489354
Name:FAMILY WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:FAMILY WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:OLATERU-OLAGBEGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-545-8359
Mailing Address - Street 1:3883 ROGERS BRIDGE RD
Mailing Address - Street 2:STE 202A
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2802
Mailing Address - Country:US
Mailing Address - Phone:770-545-8359
Mailing Address - Fax:
Practice Address - Street 1:3883 ROGERS BRIDGE RD
Practice Address - Street 2:STE 202A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2802
Practice Address - Country:US
Practice Address - Phone:770-545-8359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health