Provider Demographics
NPI:1508139031
Name:STRONG WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:STRONG WELLNESS CENTER LLC
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-289-9002
Mailing Address - Street 1:1100 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9105
Mailing Address - Country:US
Mailing Address - Phone:678-289-9002
Mailing Address - Fax:678-289-9003
Practice Address - Street 1:1100 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9105
Practice Address - Country:US
Practice Address - Phone:678-289-9002
Practice Address - Fax:678-289-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39485261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care