Provider Demographics
NPI:1407921315
Name:CARTERSVILLE WELLNESS DIAGNOSTICS
Entity Type:Organization
Organization Name:CARTERSVILLE WELLNESS DIAGNOSTICS
Other - Org Name:AMERICAN WELLNESS DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENSCHIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:281-381-8838
Mailing Address - Street 1:12 E GREENWAY PLZ
Mailing Address - Street 2:STE 700
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-1203
Mailing Address - Country:US
Mailing Address - Phone:281-381-8838
Mailing Address - Fax:866-241-8647
Practice Address - Street 1:31 POINTE NORTH DR
Practice Address - Street 2:STE 105
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121
Practice Address - Country:US
Practice Address - Phone:770-607-1840
Practice Address - Fax:706-607-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3637Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID