Provider Demographics
NPI:1740025246
Name:WALK IN WELLNESS LLC
Entity type:Organization
Organization Name:WALK IN WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK-DICKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-666-2926
Mailing Address - Street 1:75 WASHINGTON ST UNIT 383
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3604
Mailing Address - Country:US
Mailing Address - Phone:973-666-2926
Mailing Address - Fax:
Practice Address - Street 1:111 EPPS ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:GA
Practice Address - Zip Code:31031-3805
Practice Address - Country:US
Practice Address - Phone:678-437-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)