Provider Demographics
NPI:1063942886
Name:ATLANTA HOLISTIC HEALTH CENTER
Entity type:Organization
Organization Name:ATLANTA HOLISTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:JIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-697-6886
Mailing Address - Street 1:455 VILLA PLACE CT
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-1958
Mailing Address - Country:US
Mailing Address - Phone:404-697-6886
Mailing Address - Fax:470-823-4926
Practice Address - Street 1:320 WINN WAY STE 101
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2106
Practice Address - Country:US
Practice Address - Phone:404-697-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55OtherACUPUNCTURE LICENSE NUMBER