Provider Demographics
NPI:1619126166
Name:NATURAL WELLNESS CENTER OF ELLIJAY
Entity Type:Organization
Organization Name:NATURAL WELLNESS CENTER OF ELLIJAY
Other - Org Name:ELLIJAY MASSAGE THERAPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOULE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:706-698-4002
Mailing Address - Street 1:29 NORTH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3565
Mailing Address - Country:US
Mailing Address - Phone:706-698-4002
Mailing Address - Fax:706-698-4005
Practice Address - Street 1:29 NORTH AVE STE 1
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3565
Practice Address - Country:US
Practice Address - Phone:706-698-4002
Practice Address - Fax:706-698-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007764111N00000X
GAMT001421174400000X
174H00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty