Center for Intentional Wellness, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

CENTER FOR INTENTIONAL WELLNESS, LLC

Practice address

3295 River Exchange Dr Ste 400
Norcross, GA 30092-4221

Phone

(229) 395-8243

Fax

(678) 550-6860

NPI assigned

Feb 12, 2024

Last updated

Aug 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jamil David, PMHNP

Title

Owner

Phone

(229) 395-8243

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Jamil Eman Davis, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Riverdale, GA
  • NPI 1376882191
  NPD

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1780448670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3295 RIVER EXCHANGE DR STE 400",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300924221",
            "telephone_number": "229-395-8243",
            "fax_number": "678-550-6860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3295 RIVER EXCHANGE DR STE 400",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300924221",
            "telephone_number": "229-395-8243",
            "fax_number": "678-550-6860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR INTENTIONAL WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "DAVID",
        "authorized_official_first_name": "JAMIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-395-8243",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Norcross, GA
• Providers in Norcross, GA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.