Healthcare Provider Details

I. General information

NPI: 1356620454
Provider Name (Legal Business Name): SUPPORTING YOUR DAILY HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 NORTH AVE NE
ATLANTA GA
30308-2328
US

IV. Provider business mailing address

3695 CASCADE RD SW STE F STE 1158
ATLANTA GA
30331-2146
US

V. Phone/Fax

Practice location:
  • Phone: 404-438-7569
  • Fax:
Mailing address:
  • Phone: 404-438-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number005833
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004315
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number65587
License Number StateGA

VIII. Authorized Official

Name: YVONNE WICKS
Title or Position: MANAGER
Credential: PA
Phone: 404-790-0911