Provider Demographics
NPI:1336423409
Name:BALANCED FAMILY WELLNESS
Entity Type:Organization
Organization Name:BALANCED FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCGEHEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-683-6884
Mailing Address - Street 1:931 LOWER FAYETTEVILLE RD STE H
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5790
Mailing Address - Country:US
Mailing Address - Phone:404-936-8546
Mailing Address - Fax:770-252-5630
Practice Address - Street 1:931 LOWER FAYETTEVILLE RD STE H
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-5790
Practice Address - Country:US
Practice Address - Phone:706-683-6884
Practice Address - Fax:770-252-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2021356891Medicare PIN