Provider Demographics
NPI:1659823425
Name:EVERWELL ACUPUNCTURE CENTER LLC
Entity Type:Organization
Organization Name:EVERWELL ACUPUNCTURE CENTER LLC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:TCMD
Authorized Official - Phone:678-273-2472
Mailing Address - Street 1:1230 JOHNSON FERRY PL
Mailing Address - Street 2:SUITE I-20
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068
Mailing Address - Country:US
Mailing Address - Phone:678-273-2472
Mailing Address - Fax:
Practice Address - Street 1:1230 JOHNSON FERRY PL
Practice Address - Street 2:SUITE I-20
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2048
Practice Address - Country:US
Practice Address - Phone:678-273-2472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization