Provider Demographics
NPI:1992026330
Name:PERIMETER HEALTH AND WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:PERIMETER HEALTH AND WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-236-8686
Mailing Address - Street 1:1838 OLD NORCROSS RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8804
Mailing Address - Country:US
Mailing Address - Phone:770-236-8686
Mailing Address - Fax:770-236-8687
Practice Address - Street 1:1838 OLD NORCROSS RD
Practice Address - Street 2:STE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8804
Practice Address - Country:US
Practice Address - Phone:770-236-8686
Practice Address - Fax:770-236-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA084728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty