NPIMap

Organization Active NPI

Phoenix Wellness Center LLC

  • General Practice Physician
  • Atlanta, GA
National Provider Identifier
1316135643
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PHOENIX WELLNESS CENTER LLC
Practice address
142 Mitchell St SW
Suite 200
Atlanta, GA 30303-3439
Phone
(404) 584-2105
Fax
(404) 584-2106
NPI assigned
Oct 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Authorized official

Name
Mr. Fabian Centeno
Title
President
Phone
(404) 584-2105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

142 Mitchell St SW
Suite 200
Atlanta, GA 30303-3439

Mailing address

142 Mitchell St SW
Suite 200
Atlanta, GA 30303-3439
Phone (404) 584-2105

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1316135643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 MITCHELL ST SW",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303033439",
            "telephone_number": "404-584-2105",
            "fax_number": "404-584-2106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 MITCHELL ST SW",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303033439",
            "telephone_number": "404-584-2105",
            "fax_number": "404-584-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "CENTENO",
        "authorized_official_first_name": "FABIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-584-2105",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; 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.