Healthcare Provider Details

I. General information

NPI: 1093625444
Provider Name (Legal Business Name): THE BORN AND BLOOM COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 NORWOOD PARK XING
ATLANTA GA
30340-1857
US

IV. Provider business mailing address

2447 NORWOOD PARK XING
ATLANTA GA
30340-1857
US

V. Phone/Fax

Practice location:
  • Phone: 443-204-2367
  • Fax:
Mailing address:
  • Phone: 443-204-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MRS. CANDICE MICHELLE THOMAS
Title or Position: OWNER
Credential:
Phone: 443-204-2367