Provider Demographics
NPI:1942418835
Name:PEACHTREE WELLNESS CENTER, PC
Entity Type:Organization
Organization Name:PEACHTREE WELLNESS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-475-0386
Mailing Address - Street 1:1401 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3023
Mailing Address - Country:US
Mailing Address - Phone:404-475-0386
Mailing Address - Fax:404-475-0443
Practice Address - Street 1:1401 PEACHTREE ST NE
Practice Address - Street 2:SUITE 160
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3023
Practice Address - Country:US
Practice Address - Phone:404-475-0386
Practice Address - Fax:404-475-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G704630Medicare PIN