Provider Demographics
NPI:1386022184
Name:FAMILY HEALTH & WELLNESS CENTERS OF GEORGIA, LLC
Entity Type:Organization
Organization Name:FAMILY HEALTH & WELLNESS CENTERS OF GEORGIA, LLC
Other - Org Name:FAMILYWELLNESSMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:DEBORAH
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-625-0531
Mailing Address - Street 1:3371 N BERKELEY LAKE RD NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BERKELEY LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4367
Mailing Address - Country:US
Mailing Address - Phone:404-625-0531
Mailing Address - Fax:
Practice Address - Street 1:3371 N BERKELEY LAKE RD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:BERKELEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30096-4367
Practice Address - Country:US
Practice Address - Phone:404-625-0531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056229261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center