Provider Demographics
NPI:1366039497
Name:THREEROOTS WELLNESS LLC
Entity Type:Organization
Organization Name:THREEROOTS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURGUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-362-9455
Mailing Address - Street 1:708 COVENTRY TOWNSHIP LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3248
Mailing Address - Country:US
Mailing Address - Phone:770-362-9455
Mailing Address - Fax:
Practice Address - Street 1:1355 TERRELL MILL RD SE STE 205
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5496
Practice Address - Country:US
Practice Address - Phone:678-701-7154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)