Complete Wellness Diagnostic Lab, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

COMPLETE WELLNESS DIAGNOSTIC LAB, LLC

Practice address

1514 Riverbrooke Way NE
Conyers, GA 30012-6624

Phone

(678) 643-0885

NPI assigned

Mar 15, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charnika PorterNPI 1104668193

Title

Owner/Administrator

Phone

(678) 643-0885

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charnika Porter

  • Behavior Technician
  • Conyers, GA
  • NPI 1104668193
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1013665355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 RIVERBROOKE WAY NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300126624",
            "telephone_number": "678-643-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 RIVERBROOKE WAY NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300126624",
            "telephone_number": "678-643-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE WELLNESS DIAGNOSTIC LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-15",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "CHARNIKA",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "678-643-0885"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Conyers, GA
• Providers in Conyers, GA by specialty
• Health Service Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.