Provider Demographics
NPI:1780338467
Name:ELITE WELLNESS SOLUTIONS, LLC
Entity type:Organization
Organization Name:ELITE WELLNESS SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHALONDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MMSC, PA, CHC
Authorized Official - Phone:770-317-5743
Mailing Address - Street 1:3401 NORMAN BERRY DR STE 111
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5102
Mailing Address - Country:US
Mailing Address - Phone:404-225-2794
Mailing Address - Fax:
Practice Address - Street 1:3401 NORMAN BERRY DR STE 111
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5102
Practice Address - Country:US
Practice Address - Phone:404-225-2794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date: