MEDICARE: HEALTHYPRO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1457928319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHYPRO LLC

Provider Business Mailing Address
First Line	:	3784 HARRIS BLVD NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-6098
Country	:	US
Telephone Number	:	954-770-7059
Fax Number	:

Provider Business Practice Location Address
First Line	:	3784 HARRIS BLVD NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-6098
Country	:	US
Telephone Number	:	954-770-7059
Fax Number	:

Authorized Official
Title or Position	:	APRN/MANAGER
Name	:	EMMANUELLE CHASSAGNE
Credential	:	ADVANCE PRACTIC
Telephone Number	:	954-770-7059

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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Directions to “HEALTHYPRO LLC ” Practice Location

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