NPIMap

Organization Active NPI

Wonderfully Made Wellness, Inc.

  • Specialist
  • Mableton, GA
National Provider Identifier
1649677626
Registry record updated Nov 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
WONDERFULLY MADE WELLNESS, INC.
Practice address
464 Vinings Vintage Circle SE
Mableton, GA 30126
Phone
(770) 853-3216
NPI assigned
Nov 19, 2014
Organization subpart
Yes
Parent organization
WONDERFULLY MADE HEALTH & FITNESS SOLUTIONS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2014

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

Authorized official

Name
Qura Woodbury, MS, ACSM-HFSNPI 1558787085
Title
Executive Director
Phone
(770) 853-3216

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

464 Vinings Vintage Circle SE
Mableton, GA 30126

Mailing address

464 Vinings Vintage Circle SE
Mableton, GA 30126

National Provider Directory

National Provider Directory
Part of
Wonderfully Made Health Fitness Solutions

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416355200000",
    "number": "1649677626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "464 VININGS VINTAGE CIRCLE SE",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "30126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 VININGS VINTAGE CIRCLE SE",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "30126",
            "telephone_number": "770-853-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WONDERFULLY MADE WELLNESS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WONDERFULLY MADE HEALTH & FITNESS SOLUTIONS, LLC",
        "enumeration_date": "2014-11-19",
        "last_updated": "2014-11-19",
        "status": "A",
        "authorized_official_last_name": "WOODBURY",
        "authorized_official_first_name": "QURA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "770-853-3216",
        "authorized_official_credential": "MS, ACSM-HFS"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mableton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2014; 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.