Basic Information
| Provider Information | |||||||||
| NPI: | 1053919225 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIND AND BODY WELLNESS CENTER INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3180 N POINT PKWY STE 302 | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300054381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782248686 | ||||||||
| FaxNumber: | 4048005797 | ||||||||
| Practice Location | |||||||||
| Address1: | 3180 N POINT PKWY STE 302 | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300054381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048005181 | ||||||||
| FaxNumber: | 4048005797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2020 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | BACHAR | ||||||||
| AuthorizedOfficialFirstName: | MOSHE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4048005181 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0401X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.