Provider Demographics
NPI:1548551344
Name:FITMED WELLNESS, LLC
Entity type:Organization
Organization Name:FITMED WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-552-3232
Mailing Address - Street 1:9420 WILLEO RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6772
Mailing Address - Country:US
Mailing Address - Phone:770-552-3232
Mailing Address - Fax:770-552-3230
Practice Address - Street 1:9420 WILLEO RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-6772
Practice Address - Country:US
Practice Address - Phone:770-552-3232
Practice Address - Fax:770-552-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty