Provider Demographics
NPI:1235890070
Name:ASSURANCE WELLNESS LLC
Entity Type:Organization
Organization Name:ASSURANCE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:404-376-4504
Mailing Address - Street 1:976 KATHRYN CT
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-6204
Mailing Address - Country:US
Mailing Address - Phone:404-376-4504
Mailing Address - Fax:
Practice Address - Street 1:69 SAINT PAUL RD
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:GA
Practice Address - Zip Code:30425-3823
Practice Address - Country:US
Practice Address - Phone:404-376-4504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty