MEDICARE: HOLISTIC APPROACH WELLNESS CENTER

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	1710I1002X	Independent Duty Corpsman
2	174H00000X	Health Educator	N/A	GA
3	175L00000X	Homeopath
4	175F00000X	Naturopath

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000	OTHER	GA	NONE

General Provider Information

NPI Number	:	1851625370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC APPROACH WELLNESS CENTER

Provider Business Mailing Address
First Line	:	5744 AUSTELL POWDER SPRINGS RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-3231
Country	:	US
Telephone Number	:	678-558-3968
Fax Number	:	678-623-0298

Provider Business Practice Location Address
First Line	:	5744 AUSTELL POWDER SPRINGS RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-3231
Country	:	US
Telephone Number	:	678-558-3968
Fax Number	:	678-623-0298

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOY EDWARDS
Credential	:
Telephone Number	:	678-558-3968

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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