Provider Demographics
NPI:1629693411
Name:PRIORITY HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:PRIORITY HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:770-686-7002
Mailing Address - Street 1:280 MERCHANTS DR UNIT 340
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0702
Mailing Address - Country:US
Mailing Address - Phone:770-686-7002
Mailing Address - Fax:
Practice Address - Street 1:3855 OAKVIEW DR STE 400
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2233
Practice Address - Country:US
Practice Address - Phone:770-686-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service