Healthcare Provider Details

I. General information

NPI: 1558734434
Provider Name (Legal Business Name): HOLISTIC HEALTH AND COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 LEMOYNE DR SW
ATLANTA GA
30331-9206
US

IV. Provider business mailing address

5460 LEMOYNE DR SW
ATLANTA GA
30331-9206
US

V. Phone/Fax

Practice location:
  • Phone: 404-349-0058
  • Fax: 866-323-6778
Mailing address:
  • Phone: 404-349-0058
  • Fax: 866-323-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNIE HOLLINGSWORTH
Title or Position: ADMINISTRATOR
Credential: HOLISTIC SPECIALIST
Phone: 404-349-0058