Provider Demographics
NPI:1467196477
Name:WELLNESS IV SPA & MEDICAL WEIGHT LOSS CENTER
Entity Type:Organization
Organization Name:WELLNESS IV SPA & MEDICAL WEIGHT LOSS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHUMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:773-954-4476
Mailing Address - Street 1:9207 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5409
Mailing Address - Country:US
Mailing Address - Phone:773-954-4476
Mailing Address - Fax:470-239-1128
Practice Address - Street 1:629 HOLCOMB BRIDGE RD STE 120
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1511
Practice Address - Country:US
Practice Address - Phone:773-954-4476
Practice Address - Fax:470-239-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty