Healthcare Provider Details

I. General information

NPI: 1700231875
Provider Name (Legal Business Name): ATLANTA INTEGRATIVE HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 BUFORD HWY NE SUITE 290
ATLANTA GA
30324-3207
US

IV. Provider business mailing address

PO BOX 550747
ATLANTA GA
30355-3247
US

V. Phone/Fax

Practice location:
  • Phone: 404-477-1797
  • Fax:
Mailing address:
  • Phone: 404-477-1797
  • Fax: 404-477-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number005937
License Number StateGA

VIII. Authorized Official

Name: ALESIA REYNOLDS
Title or Position: OWNER
Credential:
Phone: 404-477-1797