Norcross Wellness Center LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

NORCROSS WELLNESS CENTER LLC

Practice address

3850 Holcomb Bridge Rd Ste 215
Peachtree Corners, GA 30092-5219

Phone

(704) 305-1430

Fax

(770) 637-5377

NPI assigned

Feb 2, 2022

Organization subpart

No

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

Authorized official

Name

Justin Heilig

Title

Chief Executive Officer

Phone

(704) 305-1430

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1643760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1780337337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 HOLCOMB BRIDGE RD STE 215",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300925219",
            "fax_number": "770-637-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 HOLCOMB BRIDGE RD STE 215",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300925219",
            "telephone_number": "704-305-1430",
            "fax_number": "770-637-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORCROSS WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-02",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "HEILIG",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "704-305-1430"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAMBIZ AFLATOON, DO",
            "identifier": "66238",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "KIPU",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3850 Holcomb Bridge Rd Ste 215",
            "city": "Peachtree Corners",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300925219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinic/Center in Peachtree Corners, GA
• Providers in Peachtree Corners, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.