Healthcare Provider Details

I. General information

NPI: 1679300834
Provider Name (Legal Business Name): ATLANTA ENERGY MEDICINE PRACTICE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PEACHTREE ST NW STE 2200
ATLANTA GA
30303-1292
US

IV. Provider business mailing address

1328 PEACHTREE ST NE
ATLANTA GA
30309-3209
US

V. Phone/Fax

Practice location:
  • Phone: 838-333-3989
  • Fax:
Mailing address:
  • Phone: 838-333-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ETHENIA A SCOTT
Title or Position: ENERGY MEDICINE PRACTITIONER
Credential: C-EM
Phone: 838-333-3989