Provider Demographics
NPI:1710242409
Name:GEORGIA WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:GEORGIA WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:OYINLOLA AJOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON-WNFUNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-763-5126
Mailing Address - Street 1:145 LAUGHLIN DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-6012
Mailing Address - Country:US
Mailing Address - Phone:404-604-9106
Mailing Address - Fax:
Practice Address - Street 1:145 LAUGHLIN DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-6012
Practice Address - Country:US
Practice Address - Phone:404-604-9106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health