Provider Demographics
NPI:1235320748
Name:WELLNESSONE OF DULUTH
Entity Type:Organization
Organization Name:WELLNESSONE OF DULUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-850-0857
Mailing Address - Street 1:PO BOX 671971
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006-0033
Mailing Address - Country:US
Mailing Address - Phone:770-495-8338
Mailing Address - Fax:770-495-8628
Practice Address - Street 1:3294 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 2005A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8322
Practice Address - Country:US
Practice Address - Phone:770-495-8338
Practice Address - Fax:770-495-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO06451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty