| Rising Phoenix Health And Wellness Empowerment Center, Llc | |
|
2395 Wall St Se Ste 170 Conyers GA 30013-6703 | |
| (404) 200-7754 | |
| Not Available |
| Full Name | Rising Phoenix Health And Wellness Empowerment Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2395 Wall St Se Ste 170, Conyers, Georgia |
| Authorized Official Name and Position | Samira Smith (OWNER) |
| Authorized Official Contact | 4042007754 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rising Phoenix Health And Wellness Empowerment Center, Llc 1543 Lilburn Stone Mountain Rd Stone Mountain GA 30087-1851 Ph: (404) 200-7754 | Rising Phoenix Health And Wellness Empowerment Center, Llc 2395 Wall St Se Ste 170 Conyers GA 30013-6703 Ph: (404) 200-7754 |
| NPI Number | 1194411496 |
|---|---|
| Provider Enumeration Date | 04/11/2023 |
| Last Update Date | 06/13/2024 |
| Certification Date | 06/13/2024 |
| Medicare PECOS PAC ID | 1759721129 |
|---|---|
| Medicare Enrollment ID | O20240502000375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194411496 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 171400000X | Health & Wellness Coach | (* (Not Available)) | Secondary |
| Provider Name | Samira Desree Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407432990 PECOS PAC ID: 3577903947 Enrollment ID: I20240502000585 |
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