| Urban Wellness, Llc | |
|
3070 N Main St Nw Kennesaw GA 30144-2756 | |
| (770) 285-7321 | |
| (770) 285-7619 |
| Full Name | Urban Wellness, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3070 N Main St Nw, Kennesaw, Georgia |
| Authorized Official Name and Position | Erica Michelle Grant (OWNER) |
| Authorized Official Contact | 7702857321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Urban Wellness, Llc 3070 N Main St Nw Kennesaw GA 30144-2756 Ph: (770) 285-7321 | Urban Wellness, Llc 3070 N Main St Nw Kennesaw GA 30144-2756 Ph: (770) 285-7321 |
| NPI Number | 1326713231 |
|---|---|
| Provider Enumeration Date | 08/12/2021 |
| Last Update Date | 08/12/2021 |
| Certification Date | 08/12/2021 |
| Medicare PECOS PAC ID | 3678963014 |
|---|---|
| Medicare Enrollment ID | O20211129002334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326713231 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Erica Michelle Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801170402 PECOS PAC ID: 4385860048 Enrollment ID: I20211201003175 |
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