Shallowford Wellness Center LLC
Community/Behavioral Health in Atlanta, GA. Organization (NPI-2).
NPI number1235917469
StatusActive
Last updated in NPPESAug 4, 2025
Details
- NPI
- 1235917469
- Entity type
- Organization (NPI-2)
- Legal business name
- Shallowford Wellness Center LLC
- Organization subpart
- No
- Enumeration date
- Sep 19, 2023
- Certification date
- Aug 4, 2025
- Last updated
- Aug 4, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
| 2084P0005X | Psychiatry & Neurology, Neurodevelopmental Disabilities | – | – | |
| 2084P0800X | Psychiatry & Neurology, Psychiatry | – | – |
Practice location
3300 Northeast Expy NeAtlanta, GA 30341-3932
Phone 404-435-6604
Mailing address
2521 Oak Grove Ests NeAtlanta, GA 30345-7601
Authorized official
Sofia Khan
Ceo
4044356604
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