Provider Demographics
NPI:1780337337
Name:NORCROSS WELLNESS CENTER LLC
Entity type:Organization
Organization Name:NORCROSS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEILIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-305-1430
Mailing Address - Street 1:3850 HOLCOMB BRIDGE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:770-637-5377
Practice Address - Street 1:3850 HOLCOMB BRIDGE RD STE 215
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-5219
Practice Address - Country:US
Practice Address - Phone:704-305-1430
Practice Address - Fax:770-637-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA66238OtherKAMBIZ AFLATOON, DO