Provider Demographics
NPI:1982122974
Name:SUNNY ROSE INTEGRATIVE HEALTHCARE SERVICES P.C.
Entity type:Organization
Organization Name:SUNNY ROSE INTEGRATIVE HEALTHCARE SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:AYJANAH
Authorized Official - Middle Name:RASHEEDA
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-944-1174
Mailing Address - Street 1:3900 CROWN UNIT 162432
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30321-3714
Mailing Address - Country:US
Mailing Address - Phone:404-944-1174
Mailing Address - Fax:
Practice Address - Street 1:3900 CROWN UNIT 162432
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30321-3714
Practice Address - Country:US
Practice Address - Phone:404-944-1174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health