Provider Demographics
NPI:1225505217
Name:KENNESAW HEALTH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:KENNESAW HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-773-1130
Mailing Address - Street 1:1595 KENNESAW DUE WEST RD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7640
Mailing Address - Country:US
Mailing Address - Phone:470-308-3365
Mailing Address - Fax:770-627-5228
Practice Address - Street 1:1595 KENNESAW DUE WEST RD NW STE 100
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7640
Practice Address - Country:US
Practice Address - Phone:470-308-3365
Practice Address - Fax:770-627-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-28
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty