Provider Demographics
NPI:1871399212
Name:LODEBAR HEALTH AND WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:LODEBAR HEALTH AND WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CONSEILLANT
Authorized Official - Suffix:
Authorized Official - Credentials:NP-BC
Authorized Official - Phone:229-234-9695
Mailing Address - Street 1:2945 STONE HOGAN CONNECTOR RD SW STE 205
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2839
Mailing Address - Country:US
Mailing Address - Phone:404-343-1846
Mailing Address - Fax:
Practice Address - Street 1:2945 STONE HOGAN CONNECTOR RD SW STE 205
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2839
Practice Address - Country:US
Practice Address - Phone:229-234-9695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty