Provider Demographics
NPI:1457787350
Name:ROYAL WELLNESS INTERNATIONAL, INC.
Entity Type:Organization
Organization Name:ROYAL WELLNESS INTERNATIONAL, INC.
Other - Org Name:ROYAL WELLNESS CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDAY
Authorized Official - Middle Name:ALABA
Authorized Official - Last Name:FAWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-289-7150
Mailing Address - Street 1:801 BERRYMAN PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8297
Mailing Address - Country:US
Mailing Address - Phone:770-289-7150
Mailing Address - Fax:678-377-6836
Practice Address - Street 1:2488 SCENIC HWY S
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5710
Practice Address - Country:US
Practice Address - Phone:770-289-7150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55514261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1164591913OtherNPI