Provider Demographics
NPI:1679877898
Name:THE INJURY WELLNESS INSTITUTE LLC
Entity type:Organization
Organization Name:THE INJURY WELLNESS INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-439-7575
Mailing Address - Street 1:2483 POWDER SPRINGS RD SW STE C
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4573
Mailing Address - Country:US
Mailing Address - Phone:770-439-7575
Mailing Address - Fax:770-439-7550
Practice Address - Street 1:2483 POWDER SPRINGS RD SW STE C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4573
Practice Address - Country:US
Practice Address - Phone:770-439-7575
Practice Address - Fax:770-439-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty