Provider Demographics
NPI:1750683736
Name:ALPHARETTA PROADJUSTER WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ALPHARETTA PROADJUSTER WELLNESS CENTER LLC
Other - Org Name:ALPHA PRO WELLNESS & HEALTH CENTERS/CLINICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DR. FAHEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-630-2882
Mailing Address - Street 1:2947 THISTLEDOWN CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3442
Mailing Address - Country:US
Mailing Address - Phone:770-630-2882
Mailing Address - Fax:404-458-3457
Practice Address - Street 1:1 BALTIMORE PL NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2116
Practice Address - Country:US
Practice Address - Phone:770-630-2882
Practice Address - Fax:770-651-8039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008044208D00000X
GA008057208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty