Provider Demographics
NPI:1275901449
Name:MILESTONE WELLNESS MEDICAL LLC
Entity Type:Organization
Organization Name:MILESTONE WELLNESS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOJGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-862-0372
Mailing Address - Street 1:8470 HOLCOMB BRIDGE RD
Mailing Address - Street 2:140
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1854
Mailing Address - Country:US
Mailing Address - Phone:678-461-9337
Mailing Address - Fax:678-461-9338
Practice Address - Street 1:8470 HOLCOMB BRIDGE RD
Practice Address - Street 2:140
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1854
Practice Address - Country:US
Practice Address - Phone:678-461-9337
Practice Address - Fax:678-461-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032720133VN1006X
GA061005133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM1144255399OtherHEALTHCARE PROVIDER
GA1447494885OtherHEALTHCARE PROVIDER