Provider Demographics
NPI:1467191965
Name:LIVING WELL CLINICAL SERVICES INC
Entity Type:Organization
Organization Name:LIVING WELL CLINICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-260-7998
Mailing Address - Street 1:79 HWY 286
Mailing Address - Street 2:UNIT A
Mailing Address - City:ETON
Mailing Address - State:GA
Mailing Address - Zip Code:30724
Mailing Address - Country:US
Mailing Address - Phone:706-971-3893
Mailing Address - Fax:
Practice Address - Street 1:79 HWY 286
Practice Address - Street 2:UNIT A
Practice Address - City:ETON
Practice Address - State:GA
Practice Address - Zip Code:30724
Practice Address - Country:US
Practice Address - Phone:706-971-3893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty