Provider Demographics
NPI:1700159126
Name:LINK WELLNESS CENTERS LLC
Entity Type:Organization
Organization Name:LINK WELLNESS CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TEFYLON
Authorized Official - Middle Name:VELVETTE
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-325-1234
Mailing Address - Street 1:1989 N WILLIAMSBURG DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5998
Mailing Address - Country:US
Mailing Address - Phone:404-325-1234
Mailing Address - Fax:404-325-5678
Practice Address - Street 1:1989 N WILLIAMSBURG DR
Practice Address - Street 2:SUITE F
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5998
Practice Address - Country:US
Practice Address - Phone:404-325-1234
Practice Address - Fax:404-325-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6687580001OtherDME PTAN