1407921315 NPI number — CARTERSVILLE WELLNESS DIAGNOSTICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407921315 NPI number — CARTERSVILLE WELLNESS DIAGNOSTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARTERSVILLE WELLNESS DIAGNOSTICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407921315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 E GREENWAY PLZ
Provider Second Line Business Mailing Address:
STE 700
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77046-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-381-8838
Provider Business Mailing Address Fax Number:
866-241-8647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 POINTE NORTH DR
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-607-1840
Provider Business Practice Location Address Fax Number:
706-607-8142
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARENSCHIELD
Authorized Official First Name:
PAIGE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
281-381-8838

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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