Physical Wellness Group, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

027597 Issued in GA

Legal business name

PHYSICAL WELLNESS GROUP, LLC

Practice address

4153 Flat Shoals Pkwy
BLDG a
Decatur, GA 30034-4106

Phone

(888) 683-2304

NPI assigned

Apr 23, 2015

Organization subpart

No

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

Authorized official

Name

Harvey B Leslie, M.D.

Title

Ceo

Phone

(888) 683-2304

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429747200000",
    "number": "1487041745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11877 DOUGLAS RD STE 102299",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300054325",
            "telephone_number": "888-683-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4153 FLAT SHOALS PKWY",
            "address_2": "BLDG A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300344106",
            "telephone_number": "888-683-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL WELLNESS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2015-04-23",
        "status": "A",
        "authorized_official_last_name": "LESLIE",
        "authorized_official_first_name": "HARVEY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "888-683-2304",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "027597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Decatur, GA
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• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; 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.