Provider Demographics
NPI:1710731575
Name:WELLVIA INC
Entity Type:Organization
Organization Name:WELLVIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAGOMENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-438-8446
Mailing Address - Street 1:2472 JETT FERRY RD # 400-456
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3059
Mailing Address - Country:US
Mailing Address - Phone:770-438-8446
Mailing Address - Fax:470-704-4378
Practice Address - Street 1:6330 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-1617
Practice Address - Country:US
Practice Address - Phone:770-438-8446
Practice Address - Fax:470-704-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty