Provider Demographics
NPI:1821484429
Name:INNOVATIVE HEALTH & WELLNESS BUCKHEAD
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH & WELLNESS BUCKHEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORLANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-816-0222
Mailing Address - Street 1:3115 PIEDMONT RD NE
Mailing Address - Street 2:STE. 101-A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2529
Mailing Address - Country:US
Mailing Address - Phone:404-816-0222
Mailing Address - Fax:404-464-7699
Practice Address - Street 1:3115 PIEDMONT RD NE
Practice Address - Street 2:STE. 101-A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2529
Practice Address - Country:US
Practice Address - Phone:404-816-0222
Practice Address - Fax:404-464-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty