Provider Demographics
NPI:1942889910
Name:GH WELLNESS LLC
Entity Type:Organization
Organization Name:GH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICKNEAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-248-6172
Mailing Address - Street 1:3232 PEACHTREE RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2407
Mailing Address - Country:US
Mailing Address - Phone:470-248-6172
Mailing Address - Fax:
Practice Address - Street 1:225 W 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10122-0049
Practice Address - Country:US
Practice Address - Phone:470-248-6172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service