Healthcare Provider Details

I. General information

NPI: 1508318486
Provider Name (Legal Business Name): THRIVE NOW NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 TED TURNER DR NW
ATLANTA GA
30303-2007
US

IV. Provider business mailing address

478 DUNBAR ST SW
ATLANTA GA
30310-3551
US

V. Phone/Fax

Practice location:
  • Phone: 678-465-7118
  • Fax:
Mailing address:
  • Phone: 678-592-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NISHISKSI CHANDLER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 678-465-7118