NPIMap

Organization Active NPI

Activating Wellness Within, LLC

  • Adult Mental Health Clinic/Center
  • Decatur, GA
National Provider Identifier
1568959591
Registry record updated Apr 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
006307 Issued in GA
Legal business name
ACTIVATING WELLNESS WITHIN, LLC
Practice address
4153 Flat Shoals Pkwy Ste 324-a
Decatur, GA 30034-4106
Phone
(404) 645-9292
NPI assigned
Apr 16, 2018
Last updated
Apr 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2018

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

Authorized official

Name
Dr. Kenika HollowayNPI 1316015969
Title
Owner
Phone
(404) 645-9292

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 006307 GA Primary

Addresses

Primary practice location

4153 Flat Shoals Pkwy Ste 324-a
Decatur, GA 30034-4106

Mailing address

4153 Flat Shoals Pkwy Ste 324-a
Decatur, GA 30034-4106
Phone (404) 645-9292

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523836800000",
    "number": "1568959591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4153 FLAT SHOALS PKWY STE 324-A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300344106",
            "telephone_number": "404-645-9292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4153 FLAT SHOALS PKWY STE 324-A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300344106",
            "telephone_number": "404-645-9292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVATING WELLNESS WITHIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-04-16",
        "status": "A",
        "authorized_official_last_name": "HOLLOWAY",
        "authorized_official_first_name": "KENIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-645-9292",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": "006307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; 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.