Provider Demographics
NPI:1255683728
Name:THE WELLNESS INSTITUTE OF GEORGIA, INC.
Entity Type:Organization
Organization Name:THE WELLNESS INSTITUTE OF GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-331-7134
Mailing Address - Street 1:120 N BERRY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3411
Mailing Address - Country:US
Mailing Address - Phone:770-331-7134
Mailing Address - Fax:
Practice Address - Street 1:120 N BERRY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3411
Practice Address - Country:US
Practice Address - Phone:770-331-7134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health