1093124059 NPI number — HANDS ON WELLNESS

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 1093124059 NPI number — HANDS ON WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANDS ON WELLNESS
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:
Provider Other Organization Name Type Code:
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:
1093124059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3411 PIERCE DR NE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CHAMBLEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30341-2411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-452-2955
Provider Business Mailing Address Fax Number:
770-676-7237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3411 PIERCE DR NE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHAMBLEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30341-2411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-452-2955
Provider Business Practice Location Address Fax Number:
770-676-7237
Provider Enumeration Date:
08/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CROFT
Authorized Official First Name:
MIRIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
770-452-2955

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  CHIRO009303 , 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)





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