Provider Type Icon

STAT WELLNESS ROSWELL NPI 1689393621


NPI Information

NPI: 1689393621
Provider Name: STAT WELLNESS ROSWELL
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 11D2234839

Address:
87 VICKERY ST
ROSWELL, GA
ZIP 30075
Phone: (404) 254-5905
Get Directions

STAT WELLNESS ROSWELL is a clinic center in Roswell, GA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). STAT WELLNESS ROSWELL NPI is 1689393621. The provider is registered as an organization entity type.

The provider's business location address is:

87 VICKERY ST
ROSWELL, GA
ZIP 30075-924
Phone: (404) 254-5905

The provider's authorized official is Kristin Corbin Oja .
The authorized official title is Ceo And Nurse Practitioner and has the following contact phone number (404) 731-6868.

The CLIA number assigned to this NPI record is 11D2234839 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/23/2022 and was last updated on 9/6/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261Q00000XClinic/CenterYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.