1790925485 NPI number — STAYFIT WELLNESS CENTER LLC

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 1790925485 NPI number — STAYFIT WELLNESS CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAYFIT WELLNESS CENTER LLC
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:
SAEIDEH PARHAM DC - ZANJANI LLC
Provider Other Organization Name Type Code:
5
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:
1790925485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 OLD ROSWELL PL
Provider Second Line Business Mailing Address:
UNIT H-400
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-1670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-205-5129
Provider Business Mailing Address Fax Number:
678-205-5132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4063 CLOISTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30062-8005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-565-6357
Provider Business Practice Location Address Fax Number:
678-205-5132
Provider Enumeration Date:
02/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PARHAM
Authorized Official First Name:
SAEIDEH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR -OWNER/PRESIDENT
Authorized Official Telephone Number:
678-887-4207

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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