Provider Demographics
NPI:1700506979
Name:ATLANTA WELLNESS MANAGEMENT CENTER, LLC
Entity Type:Organization
Organization Name:ATLANTA WELLNESS MANAGEMENT CENTER, LLC
Other - Org Name:HOPE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-880-7668
Mailing Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD # 140
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5031
Mailing Address - Country:US
Mailing Address - Phone:470-333-8000
Mailing Address - Fax:
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD # 140
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5031
Practice Address - Country:US
Practice Address - Phone:470-333-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty