Provider Demographics
NPI:1942575006
Name:THE NILE WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:THE NILE WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:IMANI
Authorized Official - Suffix:
Authorized Official - Credentials:COLON HYDROTHERAPIST
Authorized Official - Phone:404-932-9405
Mailing Address - Street 1:PO BOX 56147
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30343-0147
Mailing Address - Country:US
Mailing Address - Phone:770-454-1363
Mailing Address - Fax:
Practice Address - Street 1:3805 PRESIDENTIAL PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-3720
Practice Address - Country:US
Practice Address - Phone:770-454-1363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty