NPIMap

Organization Active NPI

Mediwellness, LLC

  • Neurology Chiropractor
  • Tucker, GA
National Provider Identifier
1750615464
Registry record updated Sep 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology ChiropractorTaxonomy code 111NN0400X
Legal business name
MEDIWELLNESS, LLC
Practice address
2227 Idlewood Rd
Suite 200
Tucker, GA 30084-4827
Phone
(678) 531-9692
NPI assigned
Sep 28, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2009

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

Authorized official

Name
Fannie Clark
Title
Ceo-Director
Phone
(678) 531-9692

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NN0400X Primary

Addresses

Primary practice location

2227 Idlewood Rd
Suite 200
Tucker, GA 30084-4827

Mailing address

2227 Idlewood Rd
Suite 200
Tucker, GA 30084-4827
Phone (678) 531-9692

National Provider Directory

National Provider Directory

Locations

2227 Idlewood Rd
Ste 200
Tucker, GA 30084
Phone (678) 531-9692

NPI Registry JSON

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

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254096000000",
    "number": "1750615464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2227 IDLEWOOD RD",
            "address_2": "SUITE 200",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844827",
            "telephone_number": "678-531-9692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2227 IDLEWOOD RD",
            "address_2": "SUITE 200",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844827",
            "telephone_number": "678-531-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIWELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-28",
        "last_updated": "2009-09-28",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "FANNIE",
        "authorized_official_title_or_position": "CEO-DIRECTOR",
        "authorized_official_telephone_number": "678-531-9692"
    },
    "taxonomies": [
        {
            "code": "111NN0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; 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.