Provider Demographics
NPI:1346619400
Name:HUMBLE AND HUNGRY PERFORMANCE TRAINING LLC
Entity type:Organization
Organization Name:HUMBLE AND HUNGRY PERFORMANCE TRAINING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-478-6587
Mailing Address - Street 1:1232 COLLIER RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2302
Mailing Address - Country:US
Mailing Address - Phone:404-478-6587
Mailing Address - Fax:404-806-7450
Practice Address - Street 1:1253 BLAIRWOOD CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-7490
Practice Address - Country:US
Practice Address - Phone:404-478-6587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty