Provider Demographics
NPI:1508298951
Name:PREMIER HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:PREMIER HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-271-8484
Mailing Address - Street 1:2033 BUFORD HWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2033 BUFORD HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8802
Practice Address - Country:US
Practice Address - Phone:770-271-8484
Practice Address - Fax:770-271-9787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053982GA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care