Provider Demographics
NPI:1689223711
Name:KETARA WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:KETARA WELLNESS CENTER LLC
Other - Org Name:KETARA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:AKUNNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-518-2476
Mailing Address - Street 1:1755 E PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3459
Mailing Address - Country:US
Mailing Address - Phone:404-518-2476
Mailing Address - Fax:
Practice Address - Street 1:1755 E PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3459
Practice Address - Country:US
Practice Address - Phone:404-518-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health