NPIMap

Organization Active NPI

Fitlife Wellness, LLC

  • Community/Behavioral Health Agency
  • Atlanta, GA
National Provider Identifier
1396284667
Registry record updated Feb 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
CSW005281 Issued in GA
Legal business name
FITLIFE WELLNESS, LLC
Practice address
2751 Buford Hwy NE Ste 410
Atlanta, GA 30324-5457
Phone
(404) 308-6044
NPI assigned
Feb 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2017

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

Authorized official

Name
Moniek Richardson, LCSW
Title
Owner
Phone
(404) 308-6044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X CSW005281 GA Primary

Addresses

Primary practice location

2751 Buford Hwy NE Ste 410
Atlanta, GA 30324-5457

Mailing address

2751 Buford Hwy NE Ste 410
Atlanta, GA 30324-5457
Phone (404) 308-6044

Other names 1

  • Fit While Brown, LLC Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1487376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487376000000",
    "number": "1396284667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2751 BUFORD HWY NE STE 410",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303245457",
            "telephone_number": "404-308-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 BUFORD HWY NE STE 410",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303245457",
            "telephone_number": "404-308-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FITLIFE WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-18",
        "last_updated": "2017-02-18",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "MONIEK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-308-6044",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "CSW005281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fit While Brown, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 18, 2017; 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.