Provider Demographics
NPI:1679266126
Name:CHAMPION WELLNESS, INC.
Entity type:Organization
Organization Name:CHAMPION WELLNESS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:SHNARIKA
Authorized Official - Middle Name:SIMONE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:706-489-4719
Mailing Address - Street 1:8735 DUNWOODY PL # 5313
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2995
Mailing Address - Country:US
Mailing Address - Phone:064-894-7197
Mailing Address - Fax:
Practice Address - Street 1:8735 DUNWOODY PL # 5313
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2995
Practice Address - Country:US
Practice Address - Phone:706-489-4719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty