Provider Demographics
NPI:1508358714
Name:MBS WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:MBS WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMIE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BENEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-800-8327
Mailing Address - Street 1:4784 IVY RIDGE DRIVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-1328
Mailing Address - Country:US
Mailing Address - Phone:904-563-0332
Mailing Address - Fax:
Practice Address - Street 1:62 SHAWNEE TRAIL SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:904-563-0332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies