Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Sacred Waters, LLC

Organization Other Technician · NPI 1033546049

Sacred Waters, LLC is an Other Technician in Fayetteville, Georgia. Licensed in Georgia. Registered with an NPI since 2013.

Licensed in
GA
In the registry since
2013
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

500 Lanier Ave W Ste 701
Fayetteville, GA 30214-7643
Phone: (770) 460-9122
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Other Technician (primary) Taxonomy 247200000X (GA)

Record details

NPI number1033546049
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kelly Jefferson — Managing Directo · (770) 460-9122
Other names Sacred Waters Wellness
NPI enumeratedOctober 4, 2013
Last updated in NPPESOctober 4, 2013
Mailing address500 Lanier Ave W Ste 701, Fayetteville, GA 30214-7643

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