Healthcare Provider Details

I. General information

NPI: 1376260778
Provider Name (Legal Business Name): MOV2LIV FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 PEACHTREE ST NE STE 100
ATLANTA GA
30308-2179
US

IV. Provider business mailing address

715 PEACHTREE ST NE STE 100
ATLANTA GA
30308-2179
US

V. Phone/Fax

Practice location:
  • Phone: 404-490-1237
  • Fax: 833-799-3120
Mailing address:
  • Phone: 404-490-1237
  • Fax: 833-799-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: ELANORA CARR
Title or Position: CEO
Credential:
Phone: 757-502-3537