Provider Demographics
NPI:1881461598
Name:WELLD68 LLC
Entity type:Organization
Organization Name:WELLD68 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURROGATE
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:PATTY
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-892-0687
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30156-8536
Mailing Address - Country:US
Mailing Address - Phone:770-892-0687
Mailing Address - Fax:770-892-0688
Practice Address - Street 1:1003 SHADY LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3431
Practice Address - Country:US
Practice Address - Phone:770-693-7921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies