Provider Demographics
NPI:1548151954
Name:ATLANTA SPINE AND WELLNESS ROSWELL
Entity type:Organization
Organization Name:ATLANTA SPINE AND WELLNESS ROSWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OUDEKERK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-480-3311
Mailing Address - Street 1:1792 WOODSTOCK RD STE 450
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5615
Mailing Address - Country:US
Mailing Address - Phone:404-480-3311
Mailing Address - Fax:770-727-8136
Practice Address - Street 1:1792 WOODSTOCK RD STE 450
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5615
Practice Address - Country:US
Practice Address - Phone:404-480-3311
Practice Address - Fax:770-727-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty