Provider Demographics
NPI:1629704002
Name:THRIVE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:THRIVE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:912-259-9619
Mailing Address - Street 1:421 PAGE PLACE RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-9050
Mailing Address - Country:US
Mailing Address - Phone:912-259-9619
Mailing Address - Fax:912-259-9618
Practice Address - Street 1:421 PAGE PLACE RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-9050
Practice Address - Country:US
Practice Address - Phone:912-259-9619
Practice Address - Fax:912-259-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty