Provider Demographics
NPI:1689393621
Name:STAT WELLNESS ROSWELL
Entity Type:Organization
Organization Name:STAT WELLNESS ROSWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:CORBIN
Authorized Official - Last Name:OJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-731-6868
Mailing Address - Street 1:87 VICKERY ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4924
Mailing Address - Country:US
Mailing Address - Phone:404-254-5905
Mailing Address - Fax:
Practice Address - Street 1:87 VICKERY ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4924
Practice Address - Country:US
Practice Address - Phone:404-254-5905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center