1275866410 NPI number — INNER LIGHT ENTERPRISES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275866410 NPI number — INNER LIGHT ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNER LIGHT ENTERPRISES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DBA HEALTH MATTERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275866410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11080 OLD ROSWELL ROAD
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30009-4758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-740-8228
Provider Business Mailing Address Fax Number:
770-346-9958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11080 OLD ROSWELL ROAD
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30009-4758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-740-8228
Provider Business Practice Location Address Fax Number:
770-346-9958
Provider Enumeration Date:
09/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BULMASH
Authorized Official First Name:
NELSON
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER, PRESIDENT, DOCTOR
Authorized Official Telephone Number:
770-740-8228

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  004806 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)