Provider Demographics
NPI:1235985318
Name:WELLNESS EASE LLC
Entity type:Organization
Organization Name:WELLNESS EASE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-419-3860
Mailing Address - Street 1:3225 N POINT PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4726
Mailing Address - Country:US
Mailing Address - Phone:770-307-6241
Mailing Address - Fax:833-450-5693
Practice Address - Street 1:3225 N POINT PKWY STE 103
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4726
Practice Address - Country:US
Practice Address - Phone:770-307-6241
Practice Address - Fax:833-450-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty