| Shallowford Wellness Center Llc | |
|
3300 Northeast Expy Ne Atlanta GA 30341-3932 | |
| (404) 435-6604 | |
| Not Available |
| Full Name | Shallowford Wellness Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3300 Northeast Expy Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Sofia Khan (CEO) |
| Authorized Official Contact | 4044356604 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shallowford Wellness Center Llc 2521 Oak Grove Ests Ne Atlanta GA 30345-7601 Ph: () - | Shallowford Wellness Center Llc 3300 Northeast Expy Ne Atlanta GA 30341-3932 Ph: (404) 435-6604 |
| NPI Number | 1235917469 |
|---|---|
| Provider Enumeration Date | 09/19/2023 |
| Last Update Date | 03/20/2024 |
| Certification Date | 03/20/2024 |
| Medicare PECOS PAC ID | 0749628014 |
|---|---|
| Medicare Enrollment ID | O20240430001392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235917469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0005X | Psychiatry & Neurology - Neurodevelopmental Disabilities | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Asad Mehdi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578779898 PECOS PAC ID: 0941343370 Enrollment ID: I20100921001298 |
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