Provider Demographics
NPI:1922539725
Name:MPOWERR HEALTH & WELLNESS OF ATLANTA INC.
Entity Type:Organization
Organization Name:MPOWERR HEALTH & WELLNESS OF ATLANTA INC.
Other - Org Name:THE WELL MAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOURUS
Authorized Official - Middle Name:RONNARD
Authorized Official - Last Name:JERELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:678-394-6584
Mailing Address - Street 1:3616 GINNIS RD SW UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8574
Mailing Address - Country:US
Mailing Address - Phone:678-394-6584
Mailing Address - Fax:
Practice Address - Street 1:3616 GINNIS RD SW UNIT 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8574
Practice Address - Country:US
Practice Address - Phone:678-394-6584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17028051261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health