Healthcare Provider Details

I. General information

NPI: 1164901187
Provider Name (Legal Business Name): ORCHID VITALITY COLON AND MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 14TH ST NE STE B
ATLANTA GA
30309-3696
US

IV. Provider business mailing address

244 14TH ST NE STE B
ATLANTA GA
30309-3696
US

V. Phone/Fax

Practice location:
  • Phone: 678-390-4306
  • Fax: 706-661-0249
Mailing address:
  • Phone: 678-390-4306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHTC022614
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT011362
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. S. YVETTE MERRIMAN
Title or Position: LEAD THERAPIST
Credential:
Phone: 678-390-4306